Preoperative cardiac risk (Lee)
Info
High-risk type of surgery Yes No
History of ischemic heart disease Yes No
History of congestive heart failure Yes No
History of Cerebrovascular disease Yes No
Preoperative treatment with insulin Yes No
Preoperative serum creatinine >2.0 mg/dL Yes No
R e s u l t s
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Preoperative cardiac risk
 
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Preoperative cardiac risk (Lee)

This 1999 study looked at cardiac complications that occurred in patients aged 50 years or over undergoing elective major noncardiac procedures at a tertiary-care teaching hospital.

Cardiac complications recorded included:

  • VF or Cardiac Arrest
  • Complete heart block
  • Acute myocardial infarction
  • Pulmonary edema
  • Cardiac death during admission

6 independent predictors of cardiac complications for elective major noncardiac procedures were identified.

  • High-risk type of surgery (intraperitoneal, intrathoracic, or suprainguinal vascular procedures)
  • History of ischemic heart disease *
  • History of congestive heart failure **
  • History of Cerebrovascular disease (CVA or TIA)
  • Preoperative treatment with insulin
  • Preoperative serum creatinine >2.0 mg/dL

* Ischemic heart disease defined as presence of history of myocardial infarction, current angina, current use of nitrates, positive exercise stress test or EKG with pathologic Q waves

** CHF defined as history of diagnosis of congestive heart failure, paroxysmal nocturnal dyspnea, pulmonary edema, S3 or Crackles on examination, or CXR with vascular redistribution consistent with CHF

Each item present is scored 1 point.

In the validation cohort, the rates of cardiac complications were:

  • 0 point = 0.4% [Low risk]
  • 1 points = 0.9% [Low risk]
  • 2 points = 7% [Moderate risk]
  • >=3 points = 11% [High risk]

Reference:

  • Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100(10):1043-9.