Prediction of cardiac risk before abdominal aortic reconstruction: Comparison of a revised Goldman Cardiac Risk Index and radioisotope ejection fraction
Background. A revised Goldman Cardiac Risk Index has been suggested to identify patients at higher risk for cardiac complications in patients who undergo major noncardiac surgery. The aim of this study was to test the usefulness of this model in an independent series of patients who underwent abdominal aortic surgery and to compare the index with the multiple gated acquisition (MUGA) scan in the prediction of cardiac complications. Methods. We studied 77 patients who underwent MUGA scan before elective abdominal aortic reconstruction. The revised index was calculated for each patient after recording the following five risk factors: history of ischemic heart disease, congestive heart failure, cerebrovascular disease, insulin-dependent diabetes, and creatinine level more than 2 mg/dL. Technetium-99m MUGA scan provided information about the resting left ventricular ejection fraction (LVEF) and the presence of regional wall motion abnormalities. Results. Fourteen patients (18%) had cardiac complications develop. The index proved to be a satisfactory predictor of postoperative cardiac events (P=.008), and an abnormal LVEF failed to do so (P=.1). The presence of wall abnormalities, with or without an abnormal LVEF, predicted cardiac complications (P=.004 and P=.006). Patients with a higher index score showed a tendency to have a lower LVEF (Spearman rank correlation, r=-0.43; P<.001). Wall abnormalities, with or without an abnormal LVEF, were more frequent in patients with higher scores (P=.03 and P=.009). Combining the index with the LVEF or the wall abnormalities or both could further stratify the cardiac risk (P=.004, P=.0003 and P=.0006, with χ(2) test for trend). Conclusion: For those patients who undergo elective abdominal aortic surgery, the revised Goldman Cardiac Risk Index is a simple method of evaluating cardiac risk with minimum resource implications. MUGA scan can offer additional stratification in patients judged with the index to be at high risk.