倍他乐克注射液对非心脏手术患者所伴心血管合并症的治疗效果

目的:回顾性观察倍他乐克注射液对非心脏手术患者围手术期心血管合并症的疗效和安全性. 方法:收集265例非心脏外科手术患者资料,其中采用倍他乐克注射液治疗的患者137例,采用钙离子拮抗剂128例(维拉帕米51例、恬尔心77例),均因围手术期出现快速性心律失常或高血压而静脉用药.比较两类药物在减慢心率、降低血压方面的效果. 结果:两组患者的基线资料无显著差异.与钙离子拮抗剂组相比较,倍他乐克注射液可迅速减慢心室率;但降低血压的效果不及钙离子拮抗剂.倍他乐克组不良反应少,累计发生15例次(10.9%),钙离子拮抗剂组发生30例次(23.4%). 结论:倍他乐克注射液治疗围手术期非心脏手术患者心血管合并症安全、有效.     

高血压患者非心脏手术围手术期心血管并发症的研究

目的:探讨高血压患者非心脏手术围手术期心血管并发症及心血管药物干预的影响。方法:回顾分析101例高血压患者非心脏大、中手术(观察组)的临床资料,与血压正常者64例(对照组)作比较。结果:观察组的心血管并发症明显高于对照组(P<0.05);硬膜外麻醉并发症明显高于对照组(P<0.05);腹部手术并发症明显高于对照组(P<0.05)。结论:高血压病明显增加非心脏手术围手术期心血管并发症。     

替罗非班对冠心病支架术后行非心脏手术患者围手术期抗栓治疗的观察

目的：探讨冠心病药物洗脱支架（DES）植入患者行非心脏手术围手术期的抗栓治疗方法。方法选择1年内曾因冠心病植入DES服用双联抗血小板药物期间因外科疾病需手术治疗的48例患者,随机分为低分子肝素（依诺肝素）组及替罗非班组,两组患者均于术前5d停用双联抗血小板药物,低分子肝素组应用依诺肝素皮下注射（1mg/kg,1次/12h）,替罗非班组应用替罗非班0.1μg/（kg·min）持续泵入,两组患者均于术前12h停用依诺肝素或替罗非班,术后根据外科情况,尽早恢复双联抗血小板药物使用。观察围术期新发心血管事件以及出血事件。结果两组患者桥接时间及手术方式无明显区别,围术期两组患者未发生心脏事件,肝素组发生2例牙龈出血,1例鼻出血;替罗非班组发生1例牙龈出血,1例便潜血阳性,两组患者出血发生率差异无统计学意义。3个月随访,肝素组于术后2个月发生心肌梗死1例,心绞痛再发2例,替罗非班组心绞痛再发1例,两组心脏事件发生率差异无统计学意义。结论 DES植入术后近期行非心脏手术患者围术期可以考虑应用依诺肝素或Ⅱb/Ⅲa受体拮抗剂替罗非班替代双联抗血小板药物。     

倍他乐克对心肌缺血病人围手术期保护作用的疗效观察

目的探讨倍他乐克对有心肌缺血病人进行非心脏手术的围手术期保护作用的疗效观察。方法选择经长程ECG检查提示有心肌缺血且行非心脏手术的病人80例，随机分成倍他乐克组，手术前后给予倍他乐克（25mg bid）治疗，空白对照组，常规给予扩冠、营养心肌对症治疗，术后24h再次行长程ECG检查，观察比较术前、术后长程ECG心肌缺血总负荷（TIB）水平。结果围手术期未给予倍他乐克治疗的病人，心肌缺血程度增加，而给予倍他乐克治疗的病人，心肌缺血程度明显改善。结论倍他乐克可以显著改善心肌缺血病人围手术期心肌缺血程度，防止和减少心脏事件的发生，改善病人预后。     

老年冠心病患者非心脏手术围手术期心血管事件的预测

目的探究老年冠心病患者非心脏手术围手术期心血管事件的预测情况。方法选取非心脏手术患者100例,其中冠心病患者50例,非冠心病患者50例,对2组非心脏手术患者围手术期心血管事件的发生率等进行预测。结果实验组冠心病患者在术前1天以及术后第二天的血液NT-pro BNP水平均明显高于对照组非冠心病患者(P0.05),实验组围手术期心血管事件发生率明显高于对照组(P0.05)。结论对老年心脏病非心脏手术患者实施血液NT-pro BNP水平检测,可以较好的对患者围手术期心血管事件进行预测。     

糖尿病对非心脏全麻手术患者围术期心血管事件的影响

目的观察糖尿病对非心脏全麻手术患者围术期心血管事件的影响。方法该院2011年1月—2015年5月共收治需施行大中型非心脏手术糖尿病患者256例作为观察组,并选择同期施行大中型非心脏手术非糖尿病患者260例作对照,先给以丙泊酚2.0~2.5 mg/kg,维库溴铵0.10~0.12 mg/kg,芬太尼1.5~3.0μg/kg诱导麻醉,再予喉镜插管,在监测下吸入1.0%~2.0%七氟烷,手术中应用微泵匀速给以丙泊酚4~8 mg/(kg·h),维库溴铵0.03~0.05 mg/(kg·h),芬太尼1.0~1.5μg/(kg·h),保持BIS值为(50±10)。待患者血压、血氧饱和度、肌力、意识恢复后送回病室。记录两组术中、术后严重室性心律失常、心肌缺血、不稳定性心绞痛、心肌梗死、心力衰竭等心血管事件,观察两组患者围手术期发生心血管事件的情况。结果观察组256例糖尿病患者中围手术期心血管事件发生率为30.9%,对照组260例非糖尿病患者中围手术期心血管事件发生率为1.9%,观察组围手术期心血管事件发生率明显高于对照组(P0.05)。结论糖尿病是非心脏全麻手术患者围术期心血管事件的高危因素,在高危患者中尽量减少心血管事件的危险性,可降低心血管事件的发生率和病死率,改善患者预后。     

老年消化道疾病患者围手术期死亡病例分析

目的分析老年消化道疾病患者围手术期死亡的主要原因，探讨降低病死率的方法。方法回顾性总结1990至2003年2891例老年消化道患者的临床资料，对其中61例围手术期死亡患者进行分析。用Logisitic回归方法分析患者的血红蛋白、白蛋白、血压、心脏病、糖尿病等与围手术期病死率的关系。结果在2891例中，并存心血管疾病者1338例（46．2％），呼吸系统疾病813例（28．1％），糖尿病449例（15．5％），肾功能不全348例（12．1％），贫血（血红蛋白低于110g／L）796例（26．2％），低蛋白血症（白蛋白低于35g／L）442例（22．2％），围手术期死亡61例（2．1％），死亡的主要原因为心血管系统并发症、呼吸系统并发症和肾功能衰竭等。Logisitic回归分析结果显示：术前心血管疾病、低蛋白血症与围手术期病死率明显相关。结论加强老年消化道患者围手术期的处理对降低病死率有重要意义。     

美托洛尔注射液应用于老年非心脏手术患者围手术期的观察及对Fas 细胞凋亡系统的影响

目的观察美托洛尔注射液应用于老年非心脏手术患者围手术期的疗效及其对Fas细胞凋亡系统的影响。方法将61例连续人选的老年患者（≥60岁）随机分为美托洛尔组（n=30）和安慰剂组（n=31）,术前4h口服美托洛尔/安慰剂25 mg,术后每日给予美托洛尔注射液/安慰剂60mg,分4次缓慢泵入,直到患者可以口服药物,改为25mg/次,2次/d口服。记录血压、心率、心电图及心肌型肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白I（cTnI）,用ELISA法测定sFas、sFasL。结果美托洛尔组与安慰剂组相比,术后CK-MB和cTnI均有降低。[CK-MB：6 h：（3.5±2.6）vs（7.4±8.1）IU/L,1d：（4.3±4.1）vs（8.9±9.8）IU/L,2d：（4.6±4.1）vs（9.7±8.8）IU/L,3d（2.4±2.1）vs（7.8±7.5）IU/L,P〈0.05;cTnI：1 d：（0.022±0.027）vs（0.045±0.03 1）μg/L,P〈0.05]术后S T-T改变、心律失常较安慰剂组发生例数降低。sFas和sFasL浓度美托洛尔组较安慰剂组在术后3d明显降低[sFas：3d（3.7±2.4）vs（7.7±3.0）μg/L,P〈0.01;sFasL（2.2±2.0）vs（7.0±2.7）μg/L,P〈0.01]。结论美托洛尔注射液应用于老年患者围手术期具有心脏保护作用,可降低sFas和sFasL浓度,具有一定的抗细胞凋亡作用。     

倍他乐克对非心脏手术患者围术期外周血淋巴细胞β-AR基因表达的影响

目的评价倍他乐克对非心脏手术患者围术期外周血淋巴细胞（PBL）中13肾上腺素受体（β—AR）基因表达的影响方法34例择期非心脏手术的有明确冠心病或高危因素患者，随机分为2组，A组为对照组（P=18），B组为倍他乐克组（P=16），从术前2小时一直到术后30天，口服或静注倍他乐克。采集术前一日、术后15天、术后30天的外周血淋巴细胞；应用荧光实时定量PCR检测淋巴细胞中β1-AR与β2-AR的mRNA表达水平；分析倍他乐克不同时间对淋巴细胞中β1-AR和β2-AR的mRNA表达的影响。结果A组PBL中β1-ARmRNA在术后15天，术后30天较术前均明显增加（7．04±3．37vs2．66±2．36P〈0．01；8．94±4．75vs2．66±2．36P〈0．01）；而A组的β2-ARmRNA及B组的β1-ARmRNA、β2-ARmRNA在手术前后没有显著变化（P〉0．05）结论围术期倍他乐克的应用稳定了非心脏手术患者围术期外周血淋巴细胞中β-ARmRNA的表达     

老年高血压患者非心脏手术围术期主要不良心血管事件发生风险列线图模型构建与验证

背景临床上老年高血压患者非心脏手术围术期发生主要不良心血管事件(MACE)的风险较高,通过构建个体化预测非心脏手术围术期发生MACE的列线图模型极其重要。目的构建老年高血压患者非心脏手术围术期MACE发生风险列线图模型,并评估其区分度和一致性。方法选取2017年3月至2021年1月扬州大学附属医院收治的择期进行非心脏手术的老年高血压患者244例为研究对象。根据患者非心脏手术围术期MACE发生情况,将其分为MACE组(58例)和非MACE组(186例)。收集患者临床资料,采用单因素分析及多因素Logistic回归分析探讨老年高血压患者非心脏手术围术期发生MACE的影响因素;将确定的影响因素引入R 3.6.3软件及rms程序包,构建预测老年高血压患者非心脏手术围术期MACE发生风险的列线图模型;绘制受试者工作特征(ROC)曲线以评估该列线图模型的区分度,采用校准曲线与Hosmer-Lemeshow拟合优度检验评估其一致性。结果多因素Logistic回归分析结果显示,高血压分级[OR=4.432,95%CI(1.661,11.827)]、ST段压低≥0.05 mV[OR=2.894,95%CI(1.366,6.131)]、术中输入浓缩红细胞量[OR=1.014,95%CI(1.010,1.019)]、冠心病[OR=2.444,95%CI(1.172,5.099)]是老年高血压患者非心脏手术围术期发生MACE的影响因素(P<0.05)。基于多因素Logistic回归分析结果,构建预测老年高血压患者非心脏手术围术期MACE发生风险的列线图模型,该列线图模型预测老年高血压患者非心脏手术围术期发生MACE的曲线下面积为0.825[95%CI(0.766,0.884)]。列线图模型预测老年高血压患者非心脏手术围术期MACE发生风险的校准曲线与实际曲线基本吻合,且Hosmer-Lemeshow拟合优度检验结果显示,χ2=8.958、P=0.346。结论高血压分级、ST段压低≥0.05 mV情况、术中输入浓缩红细胞量、冠心病是老年高血压患者非心脏手术围术期发生MACE的影响因素,本研究基于以上4项影响因素构建的老年高血压患者非心脏手术围术期MACE发生风险列线图模型的区分度和一致性均较好。     

Preoperative plasma N-terminal pro-brain natriuretic peptide concentration and perioperative cardiovascular risk in elderly patients.

BACKGROUND: The prediction of perioperative cardiovascular complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed, but a simpler, more practical and accurate method is needed. The purpose of this study was to determine whether the N-terminal pro-brain natriuretic peptide (NT-proBNP) concentration before operation can be used to predict perioperative cardiovascular complications in elderly patients undergoing noncardiac surgery. METHODS AND RESULTS: The study group comprised 279 patients older than 60 years who were scheduled for elective surgery. The plasma NT-proBNP concentration, clinical cardiac indices and left ventricular ejection fraction were measured prior to operation. The postoperative cardiac outcomes were followed and predictors for postoperative cardiac risk were identified. Cardiovascular complications occurred in 25 patients (9.0%). Age, the incidence of prior ischemic heart disease or congestive heart failure, and the plasma NT-proBNP concentration were significantly higher in patients with perioperative cardiovascular complications than in those without. Using receiver operating characteristic analysis to predict perioperative cardiovascular events, a cut-off value of 201 pg/ml was identified as the optimal predictor of perioperative complications, showing a sensitivity of 80.0% and specificity of 81.1%. Multivariate analysis revealed that NT-proBNP >201 pg/ml (odds ratio (OR) 7.6, 95% confidence interval (CI) 2.2-26.6, p=0.003) and revised cardiac index > or =2 (OR 6.3, 95% CI 1.7-23.8, p=0.007) were independent predictors for perioperative cardiovascular complications. CONCLUSIONS: Elevated NT-proBNP levels are independently associated with an increase in the risk of perioperative cardiovascular complications in elderly patients undergoing noncardiac and nonvascular operations.     

Prediction of cardiac and pulmonary complications related to elective abdominal and noncardiac thoracic surgery in geriatric patients

PURPOSE: Major cardiac and pulmonary complications associated with abdominal and noncardiac thoracic surgery are a common cause of mortality and serious morbidity in elderly patients. We postulated that a simple, inexpensive bicycle exercise test could provide objective documentation of cardiopulmonary reserve and, therefore, predict perioperative pulmonary as well as cardiac complications. PATIENTS AND METHODS: Prior to elective surgery, 177 patients aged 65 years or older had assessment of the clinical history, results of physical examination, electrocardiogram, chest radiograph, blood chemistries, pulmonary function test findings, supine exercise test results, Dripps classification, and Goldman cardiac risk factors. Observations in patients with and without major perioperative cardiac and/or pulmonary complications were compared using univariate analysis followed by a multivariate logistic regression procedure. RESULTS: Major perioperative complications were pulmonary in 24 patients, cardiac in 25 patients, and either cardiac or pulmonary in 39 patients. By multivariate analysis, inability to perform two minutes of supine bicycle exercise raising the heart rate above 99 beats/minute was the best predictor of perioperative pulmonary, cardiac, and combined cardiopulmonary complication (p less than 0.0005). Among 108 patients who were able to achieve these exercise criteria, cardiac or pulmonary complications occurred in 10 patients (9.3%), with one death (0.9%). Among 69 patients unable to exercise satisfactorily, cardiac or pulmonary complications occurred in 29 patients (42%), with five total deaths (7.2%). CONCLUSION: Objective measurement of exercise capacity by supine bicycle ergometry appears to be of clinical value for preoperative risk stratification for both pulmonary and cardiac complications prior to major elective abdominal or noncardiac thoracic surgery in elderly patients.     

Impact of age on perioperative complications and length of stay in patients undergoing noncardiac surgery

BACKGROUND: Major surgical procedures are performed with increasing frequency in elderly persons, but the impact of age on resource use and outcomes is uncertain. OBJECTIVE: To evaluate the influence of age on perioperative cardiac and noncardiac complications and length of stay in patients undergoing noncardiac surgery. DESIGN: Prospective cohort study. SETTING: Urban academic medical center. PATIENTS: Consecutive sample of 4315 patients 50 years of age or older who underwent nonemergent major noncardiac procedures. MEASUREMENTS: Major perioperative complications (cardiac and noncardiac), in-hospital mortality, and length of stay. RESULTS: Major perioperative complications occurred in 4.3% (44 of 1015) of patients 59 years of age or younger, 5.7% (93 of 1646) of patients 60 to 69 years of age, 9.6% (129 of 1341) of patients 70 to 79 years of age, and 12.5% (39 of 313) of patients 80 years of age or older (P < 0.001). In-hospital mortality was significantly higher in patients 80 years of age or older than in those younger than 80 years of age (0.7% vs. 2.6%, respectively). Multivariate analyses indicated an increased odds ratio for perioperative complications or in-hospital mortality in patients 70 to 79 years of age (1.8 [95% CI, 1.2 to 2.7]) and those 80 years of age or older (OR, 2.1 [CI, 1.2 to 3.6]) compared with patients 50 to 59 years of age. Patients 80 years of age or older stayed an average of 1 day more in the hospital, after adjustment for other clinical data (P = 0.001). CONCLUSIONS: Elderly patients had a higher rate of major perioperative complications and mortality after noncardiac surgery and a longer length of stay, but even in patients 80 years of age or older, mortality was low.     

Preoperative Evaluation of Patients with Possible Coronary Artery Disease

During noncardiac surgery, patients may be at risk for developing cardiac events, related to underlying coronary artery disease. Therefore, perioperative cardiac complications remain an area of clinical interest and concern in patients undergoing noncardiac surgery. Over the years, perioperative risk assessment has evolved significantly to detect surgical patients with myocardium at risk due the coronary artery disease. In addition, many efforts have been made to reduce the cardiac risk of patients undergoing noncardiac surgery. The present review article will focus on the definition of high cardiac risk surgery and will discuss patient-related cardiac risk factors. In addition, the preoperative cardiac tests available to detect patients with coronary artery disease and strategies to reduce perioperative cardiac risk, as recommended in most recent perioperative guidelines, will be outlined.     

Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay

PURPOSE: To determine the relation between cardiac and noncardiac complications and their effects on length of stay in patients undergoing noncardiac surgery. METHODS: We collected detailed information from the history, physical examination, and preoperative tests of 3970 patients aged > or =50 years who were undergoing major noncardiac procedures. Serial electrocardiograms and cardiac enzyme measurements were performed perioperatively, and cardiac and noncardiac complications were recorded prospectively. Multivariate logistic regression analysis was used to determine the association between cardiac and noncardiac complications, and linear regression was used to assess their effects on length of stay. RESULTS: Cardiac complications occurred in 84 patients (2%), and noncardiac complications developed in 510 patients (13%). Both types of complications occurred in 40 patients (1%). The most common cardiac complications were pulmonary edema (n = 42) and myocardial infarction (n = 41). The most common noncardiac complications were wound infection (n = 291), confusion (n = 87), respiratory failure requiring intubation (n = 62), deep venous thrombosis (n = 48), and bacterial pneumonia (n = 46). Patients with cardiac complications were more likely to suffer a noncardiac complication than were those without cardiac complications, even after adjustment for preoperative clinical factors (odds ratio = 6.4; 95% confidence interval [CI]: 3.9 to 10.6). Mean length of stay was markedly increased in patients who experienced cardiac (11 days; 95% CI: 9 to 12 days) or noncardiac (11 days; 95% CI: 10 to 12 days) complications, or both (15 days; 95% CI: 12 to 18 days), as compared with patients without complications (4 days; 95% CI: 3 to 4 days), even after adjustment for procedure type and clinical factors. CONCLUSION: Cardiac and noncardiac complications were strongly linked in patients undergoing noncardiac surgery. Patients who experienced one type of complication were at increased risk of developing the other type of complication as well as prolonged perioperative length of stay.     

Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study

OBJECTIVES: We sought to assess whether statins may decrease cardiac complications in patients undergoing noncardiac vascular surgery. BACKGROUND: Cardiovascular complications account for considerable morbidity in patients undergoing noncardiac surgery. Statins decrease cardiac morbidity and mortality in patients with coronary disease, and the beneficial treatment effect is seen early, before any measurable increase in coronary artery diameter. METHODS: A retrospective study recorded patient characteristics, past medical history, and admission medications on all patients undergoing carotid endarterectomy, aortic surgery, or lower extremity revascularization over a two-year period (January 1999 to December 2000) at a tertiary referral center. Recorded perioperative complication outcomes included death, myocardial infarction, ischemia, congestive heart failure, and ventricular tachyarrhythmias occurring during the index hospitalization. Univariate and multivariate logistic regressions identified predictors of perioperative cardiac complications and medications that might confer a protective effect. RESULTS: Complications occurred in 157 of 1,163 eligible hospitalizations and were significantly fewer in patients receiving statins (9.9%) than in those not receiving statins (16.5%, p = 0.001). The difference was mostly accounted by myocardial ischemia and congestive heart failure. After adjusting for other significant predictors of perioperative complications (age, gender, type of surgery, emergent surgery, left ventricular dysfunction, and diabetes mellitus), statins still conferred a highly significant protective effect (odds ratio 0.52, p = 0.001). The protective effect was similar across diverse patient subgroups and persisted after accounting for the likelihood of patients to have hypercholesterolemia by considering their propensity to use statins. CONCLUSIONS: Use of statins was highly protective against perioperative cardiac complications in patients undergoing vascular surgery in this retrospective study.     

Heart rate variability and cardiac troponin I are incremental and independent predictors of one-year all-cause mortality after major noncardiac surgery in patients at risk of coronary artery disease

OBJECTIVES: The aim of this study was to determine whether perioperative measurements of heart rate variability (HRV) and cardiac troponin I (cTnI) add additional prognostic information to established risk scores for first-year mortality in patients at risk of coronary artery disease (CAD) undergoing major noncardiac surgery. BACKGROUND: In cardiac-risk patients undergoing major noncardiac surgery, the short- and long-term prognoses are mainly influenced by perioperative cardiac complications. Heart rate variability and cTnI are important prognostic markers in patients with congestive heart failure and myocardial infarction. METHODS: In a prospective study, 173 patients with CAD or at high risk of CAD undergoing major noncardiac surgery were followed up for one year. The main outcome measure was all-cause mortality. In addition to clinical parameters and established risk scores, HRV and cTnI were assessed perioperatively. RESULTS: Twenty-eight (16%) patients died within one year. Multivariate logistic regression analysis revealed three findings that were independently associated with death within the first year after surgery: the revised cardiac risk index (odds ratio 6.2 [95% confidence interval 1.6 to 25], depressed HRV before induction of anesthesia (16.2 [2.8 to 94]), and elevation of cTnI on postoperative day 1 or 2 (9.8 [3.0 to 32]). CONCLUSIONS: Depressed HRV before induction of anesthesia and elevated cTnI postoperatively are independent and powerful predictors of one-year mortality for patients at risk of CAD undergoing major noncardiac surgery and add incremental prognostic information to established risk scores that only consider preoperative information.     

Noncardiac surgery following percutaneous coronary intervention.

Patient with coronary artery disease (CAD) undergoing major noncardiac surgery (NCS) are at increased risk of serious perioperative cardiac complications. At the same time, safety of percutaneous coronary intervention (PCI) before noncardiac surgery has been questioned. This paper reviews the available literature regarding the safety of PCI before NCS. At the same time, cardiac evaluation before NCS, perioperative medical management of patients undergoing NCS, and percutaneous coronary intervention and timing of NCS is also discussed.     

Intra-aortic balloon counterpulsation support in the high-risk cardiac patient undergoing urgent noncardiac surgery

Patients with a recent myocardial infarction, congestive heart failure, sever angina, or uncorrected multivessel coronary artery disease are at increased risk of cardiac complications after major noncardiac surgery. Although invasive hemodynamic monitoring and preoperative optimization of cardiac status may lead to some reduction in the rate of perioperative cardiac events, the mortality from such events remains high. We report our experience with the use of perioperative intra-aortic balloon counterpulsation in eight patients with unstable coronary syndromes or severe coronary artery disease who underwent urgent noncardiac surgery. There were no perioperative cardiac events while the intra-aortic balloon pump (IABP) was in place. There were two postoperative cardiac events (non-fatal myocardial infarction, congestive heart failure) in the first postoperative week after the IABP was removed. One patient required emergent femoral thrombectomy as a result of intra-aortic balloon counterpulsation and subsequently died of a gastrointestinal hemorrhage. Intra-aortic balloon counterpulsation should be considered as an adjunct to maintain hemodynamic stability for the high-risk cardiac patient about to undergo urgent or emergent noncardiac surgery.     

Prospective evaluation of cardiac risk indices for patients undergoing noncardiac surgery

BACKGROUND: Prediction of perioperative cardiac complications is important in the medical management of patients undergoing noncardiac surgery. Several indices have been developed to aid prediction, but their performance has not been systematically compared. OBJECTIVE: To compare four existing methods for predicting perioperative cardiac risk. DESIGN: Prospective cohort study. SETTING: Two teaching hospitals in London, Ontario, Canada. PATIENTS: 2,035 patients referred for medical consultation before elective or urgent noncardiac surgery. MEASUREMENTS: Myocardial infarction, unstable angina, acute pulmonary edema, or death. The indices were compared by examining the areas under their respective receiver-operating characteristic (ROC) curves. RESULTS: Cardiac complications occurred in 6.4% of patients. The area under the ROC curve was 0.625 (95% CI, 0.575 to 0.676) for the American Society of Anesthesiologists index, 0.642 (CI, 0.588 to 0.695) for the Goldman index, 0.601 (CI, 0.544 to 0.657) for the modified Detsky index, and 0.654 (0.601 to 0.708) for the Canadian Cardiovascular Society index. These values did not significantly differ. CONCLUSIONS: Existing indices for prediction of cardiac complications perform better than chance, but no index is significantly superior. There is room for improvement in our ability to predict such complications.