Evolution of ideas on the assessment of cardiovascular risks in the perioperative period

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Substantial advance has been made in operative surgery and anesthesiology; on the one hand, population ageing and, on the other, increasing surgical care needs make the prediction of perioperative complications an important component of the entire current model of surgical care. In the last decades, the concept of risk in perioperative medicine has been formulated; the theoretical base for a statistical description of the risk concept has been created, and different integral risk prediction models based on the risk index obtained by regression analysis have been elaborated and promoted. At the same time, none of the created models can reliably assess the risk of cardiovascular events associated with surgical intervention and predict the probability of poor clinical outcomes with a high degree of accuracy.

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Эволюция представлений об оценке риска развития сердечно-сосудистых осложнений в периоперационном периоде. - Аннотация. Значительные достижения в области оперативной хирургии и анестезиологии, с одной стороны, постарение населения и рост потребности в хирургической помощи, с другой, делают прогнозирование развития периоперационных осложнений важным компонентом всей современной модели оказания хирургической помощи. За последние десятилетия сформирована концепция риска в медицине периоперационного периода, создана теоретическая база для статистического описания понятия риска, разработаны и внедрены различные интегральные модели прогнозирования риска, основанные на получении индекса риска методом регрессионного анализа. В то же время пока ни одна из созданных моделей не позволяет надежно оценить риск развития сердечно-сосудистых осложнений, связанных с проведением хирургического вмешательства, и с высокой точностью прогнозировать вероятность развития неблагоприятных клинических исходов.


  1. Jones H.J., de Cossart L. Risk scoring in surgical patients. 1999; 86: 149-157.
  2. Cardoen B., Demeulemeester E., Belin J. Operating Room Planning and Scheduling: A Literature Review. Eur J Operational Research 2010; 201 (3): 921-932.
  3. Mayr V., Dunser M., Greil V. et al. Causes of death and determinants of outcome in critically ill patients. Critical Care 2006; 10: R154.
  4. Fleischmann K.E., Goldman L., Young B., Lee T.H. Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med 2003; 115: 515-520.
  5. Devereaux P.J., Goldman L., Cook D.J. et al. Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk. CMAJ 2005; 173 (6): 627-634.
  6. Auerbach A., Goldman L. Assessing and Reducing the Cardiac Risk of Noncardiac Surgery. Circulation 2006; 113: 1361-1376.
  7. Chassot P.-G., Delabays A., Spahn D.R. Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery. Br J Anaesth 2002; 89: 747-759.
  8. Conti A.A., Conti A., Gensini G.F. The concept of risk in medicine: historical and epistemological reflections. Minerva Med 2010; 101 (1): 59-62.
  9. Boyd O., Jackson N. How is risk defined in high-risk surgical patient management? Critical Care 2005; 9: 390-396.
  10. Chand M., Armstrong T., Britton G., Nash G.F. How and why do we measure surgical risk? J R Soc Med 2007;100: 508-512.
  11. Dupuis J-Y., Nathan H.J., Wynands J.E. Clinical application of cardiac risk indices: how to avoid misleading numbers. Can J Anesth 1991; 38 (8): 1055-1064.
  12. Grocott M.P.W., Pearse R.M. Prognostic studies of peri-operative risk: robust methodology is needed. Br J Anaesth 2010; 105: 243-245.
  13. Barnett S., Moonesinghe S.R. Clinical risk scores to guide perioperative management. Postgrad Med J 2011; 87: 535-541.
  14. Wilson L.B. Fatal Post-Operative Embolism. Ann Surg 1950; 132 (5): 986-993.
  15. Butler S., Feeney N., Levine S.A. The Patient with Heart Disease as a Surgical Risk. JAMA 1930; 95: 85.
  16. Purks W.K. The cause of death of patients with organic heart disease subjected to surgical operation. Ann Int Media 1934; 7 (7): 885-894.
  17. Master A.M., Dack S., Jaffe H. Perioperative coronary artery occlusion. JAMA 1938; 110: 1415-1418.
  18. Woodbridge P.D. Preoperative estimation of the anesthetic and surgical risk. Am J Surg 1936; 34 (3): 410-418.
  19. Wróblewski F., LaDue J.S. Myocardial infarction as a postoperative complication of major surgery. JAMA 1952; 150 (12): 1212-1216.
  20. Goldman L. Cardiac risk in non cardiac surgery: an update. Anesth Analg 1995; 80: 810-820.
  21. Goldman L., Caldera D.L., Nussbaum S.R. et al. Multifactorial index of cardiac risk in non-cardiac surgical procedures. N Eng J Med 1977; 297: 845-850.
  22. Ridley S. Cardiac scoring system - what the value? Anaesthesia 2003; 58: 985-991.
  23. Detsky A.S., Abrams H.B., McLaughlin J.R. et al. Predicting cardiac complications in patients undergoing noncardiac surgery. J Gen Intern Med 1986; 1: 211-219.
  24. Guidelines for assessing and managing the perioperative risk from coronary artery disease associated with major noncardiac surgery. Ann Intern Med 1997; 127: 309-312.
  25. Heinisch R.H.., Barbieri C.F., Filho J. et al. Prospective Assessment of Different Indices of Cardiac Risk for Patients Undergoing Noncardiac Surgeries. Arq Bras Cardiol 2002; 79 (4): 333-338.
  26. Larsen S.F., Olesen K.H., Jacobsen E. et al. Prediction of cardiac risk in non-cardiac surgery. Eur Heart J 1987; 8: 179-188.
  27. Shah K.B., Kleinman B.S., Rao T.L.K. et al. Angina and other risk factors in patients with cardiac diseases undergoing noncardiac operations. Anest Analg 1990; 70: 240-247.
  28. Ashton C.M., Peterson N.J., Wray N.P. et al. The incidence of perioperative myocardial infarction in men undergoing noncardiac surgery. Ann Int Med 1993; 118: 504-510.
  29. Gilbert K., Laroque B.J., Patrick L.T. Prospective evaluation of cardiac risk indices for patient undergoing noncardiac surgery. Ann Int Med 2000; 133: 356-359.
  30. Kumar R., McKinney P., Raj G. et al. Adverse cardiac events after surgery. J Gen Intern Med 2001; 16: 507-518.
  31. Pinho C., Grandini P.C., Gualandro D.M. et al. Multicenterric study of perioperative evaluation for noncardiac surgeries in Brazil (EMAPO). Clinics 2007; 62 (1): 17-22.
  32. Lee T.H., Marcantonio E.R., Mangione C.M. et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation 1999; 100: 1043-1049.
  33. Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). JACC 2007; 50 (17): e159-e241.
  34. Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. The Task Force for Preoperative Cardiac Risk Assessment and Perioperative Cardiac Management in Non-cardiac Surgery of the European Society of Cardiology (ESC) and endorsed by the European Society of Anaesthesiology (ESA). Eur Heart J 2009; 30: 2769-2812.
  35. Прогнозирование и профилактика кардиальных осложнений внесердечных хирургических вмешательств. Национальные рекомендации. Разработаны Комитетом экспертов Всероссийского научного общества кардиологов. Кардиоваск тер и проф 2011; приложение 3; 10 (6):1-28.
  36. Ford M.K., Beattie W.S., Wijeysundera D.N. Systematic review: prediction of perioperative cardiac complications and mortality by the revised cardiac risk index. Ann Int Med 2010; 152: 26-31.
  37. Reilly C.S. Can we accurately assess an individual’s perioperative risk? Br J Anaesth 2008; 101: 747-749.
  38. Boersma E., Kertai M.D., Schouten O. et al. Perioperative cardiovascular mortality in noncardiac surgery: validation of the Lee cardiac risk index. Am J Med 2005; 118: 1134-1141.
  39. Bertges D.J., Goodney P.P, Zhao Y. et al. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the revised cardiac risk index in vascular surgery patients. J Vasc Surg 2010; 52: 674-83, 83.e1-83.e3.
  40. Biccard B.M.., Rodseth R.N. Utility of clinical risk predictors for preoperative cardiovascular risk prediction. Br J Anaesthesia 2011; 107 (2): 133-143.
  41. Goldman L. The revised cardiac index delivers what it promised. Ann Nit Med 2010; 152: 570-581.
  42. Myles P.S., Devereaux P.J. Pros and cons of composite endpoints in anesthesia trials. Anesthesiology 2010; 113: 776-778.
  43. Sprung J., Abdelmalak B., Gottlieb A. et al. Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery. Anesthesiology 2000; 93: 129-140.
  44. Thygesen K., Alpert J.S., Jaffe A.S. et al. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012; 60 (16): 1581-1598.
  45. Siniorakis E., Kirvassilis G., Exadactylos N. Intraoperative myocardial infarction in non-cardiac surgery: is a universal definition feasible? Eur Heart J 2008; 29 (4): 567.
  46. Fonseca C., Morais H., Mota T. et al. The diagnosis of heart failure in primary care: value of symptoms and signs. Eur J Heart Fail 2004; 6: 795-800, 821-822.
  47. Hobbs F.D.R., Doust J., Mant J., Cowie M.R. Diagnosis of heart failure in primary care. Heart 2010; 96 (21): 1773-1777.
  48. Sparrow N., Adlam D., Cowley A., Hampton J.R. The diagnosis of heart failure in general practice: implications for the UK National Service Framework. Eur J Heart Fail 2003; 5: 349-354.
  49. Biccard B.M., Naidoo P. The role of brain natriuretic peptide in prognostication and reclassification of risk in patients undergoing vascular surgery. Anaesthesia 2011; 66: 379-385.
  50. Struthers R., Erasmus P., Holmes K. et al. Assessing fitness for surgery: a comparison of questionnaire, incremental shuttle walk, and cardiopulmonary exercise testing in general surgical patients. Br J Anaesth 2008; 101: 774-780.
  51. Fathala A., Hassan W. Role of multimodality cardiac imaging in preoperative cardiovascular evaluation before noncardiac surgery. Ann Card Anaesth 2011; 14: 134-145.
  52. Rohde L.E., Polanczyk C.A., Goldman L. et al. Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery. Am J Cardiol 2001; 87: 505-509.
  53. Choi J.H., Cho D.K., Song Y.B. et al. Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in noncardiac surgery. Heart 2010; 96: 56-62.
  54. Bae M.H., Jang S.Y., Choi W.S. et al. A New Revised Cardiac Risk Index Incorporating Fragmented QRS Complex as a Prognostic Marker in Patients Undergoing Noncardiac Vascular Surgery. Am Journal Cardiol 2013; 112 (1): 122-127.
  55. Guidelines for perioperative cardiovascular evaluation for noncardiac surgery. Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Committee on Perioperative Cardiovascular Evaluation for Noncardiac Surgery. Circulation 1996; 93: 1278-317.
  56. Urbinati S., Faggiano P., Colivicchi F. et al. Dopo le Linee Guida ACC/AHA ed ESC. La valutazione cardiologica preoperatoria nella chirugia non cardiaca: le certezze, le aree controverse e le opportunit? di una gestione in team. Monaldi Arch Chest Dis 2011; 76: 121-131.
  57. Wald N.J., Law M.R. Screening for future coronary heart disease. In: Marmont M., Elliot P. eds. Coronary Heart Disease Epidemiology. From Aetiology to Public Health, 2nd Edn. Oxford: Oxford University Press 2005; 706-713.
  58. Sniderman A.D., Furberg C.D. Age as a modifiable risk factor for cardiovascular disease. Lancet 2008; 371: 1547-1549.
  59. Cui J. Overview of risk prediction models in cardiovascular disease research. Ann Epidemiol 2009; 19: 711-717.
  60. Kertai M.D., Boersma E., Klein J. et al. Optimizing the prediction of perioperative mortality in vascular surgery by using a customized probability model. Arch Intern Med 2005; 165: 898-904.
  61. Turner E.L., DobsonJ.E., Pocock S.J. Categorisation of continuous risk factors in epidemiological publications: a survey of current practice. Epidemiol Perspectives & Innovations 2010; 7: 9.
  62. Law M.R., Wald N.J. Risk factor thresholds: their existence under scrutiny. Br Med J 2002; 324: 1570-1576.
  63. Peduzzi P., Concato J., Kemper E. et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 1996; 49: 1373-1948.
  64. Cook N.R. Statistical evaluation of prognostic versus diagnostic models: beyond the ROC curve. Clin Chem 2008; 54: 17-23.
  65. Gupta P.K., Gupta H., Sundaram A. et al. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation 2011; 124: 381-387.
  66. Carmo G.A.L., Calderaro G., Yu P.C. et al. Perioperative cardiovascular evaluation: heads or tails? Rev Assoc Med Bras 2012; 58 (4): 505-512.
  67. Choi J.J. An anesthesiologist’s philosophy on ‘medical clearance’ for surgical patients. Arch Intern Med 1987; 147: 2090-2092.

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