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2009 | 4 | 4 | 459-466

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Risk assessment in coronary patients undergoing abdominal nonvascular surgery


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The aim of our study was to establish that the incidence of perioperative cardiac complications were in direct correlation with level of operative risk in coronary patients undergoing open abdominal nonvascular surgery with general anesthesia. Our prospective observational clinical study was composed of a group of 111 consecutive patients with angiographically-verified coronary artery disease, who were operated on at the University Clinical Center of Serbia. The patients were classified into four stratification subgroups by “Goldman’s Cardiac Risk Index” (CRI) in relation to the incidence of perioperative cardiac complications. Electrocardiography was performed immediately after surgery, on postoperative days 1, 2, 7 and one day before discharge from the hospital. All patients were followed to postoperative day 30. Statistical design was presented by Pearson’s χ2 test and binomial logistic regression. The main result was significant difference between the four stratification subgroups of coronary patients in the incidence of cardiac death up to the 30th postoperative day: I - 0/17 (0.0%) vs. II - 0/40 (0.0%) vs. III - 1/37 (2.7%) vs. IV - 2/17 (11.8%), (p<0.05). We concluded that the incidence of perioperative cardiac complications significantly increased with the degree of Goldman’s CRI. There was significant difference in the incidence of perioperative cardiac complications between the four Goldman’s stratification subgroups.










Physical description


1 - 12 - 2009
3 - 10 - 2009


  • Emergency Center, Institute of Cardiovascular Diseases, University Clinical Center of Serbia, 11000, Belgrade, Serbia
  • Department of Digestive Surgery, Institute of Digestive System Diseases, University Clinical Center of Serbia, 11000, Belgrade, Serbia


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  • [2] Devereaux P.J., Goldman L., Cook D.J., Gilbert K., Leslie K., Guyatt G.H., 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, review synthese, CMAJ, 2005, 173(6), 627–634
  • [3] Eagle K.A., Berger P.B., Calkins H., Chaitman B.R., Ewy G.A., Fleischmann K.E., et al, ACC/AHA Guideline Update on Perioperative Cardiovascular for Noncardiac Surgery 2002, A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery), J. Am. Coll. Cardiol., 2002, 39(3),542–553 http://dx.doi.org/10.1016/S0735-1097(01)01788-0[Crossref][WoS]
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  • [5] Rohde L.E., Polanczyk C.A., Goldman L., Cook E.F., Lee R.T., Lee T.H. et al. Usefulness of transthoracic echocardiography as a tool for risk stratification of patients undergoing major noncardiac surgery, Am. J. Cardiol., 2001, 87(5), 505–509 http://dx.doi.org/10.1016/S0002-9149(00)01421-1[Crossref]
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  • [11] Gedebou T.M., Barr S.T., Hunter G., Sinha R., Rappaport W., VillaReal K., Risk factors in patients undergoing major nonvascular abdominal operations that predict perioperative myocardial infarction, Am. J. Surg., 1997, 174(6), 755–758 http://dx.doi.org/10.1016/S0002-9610(97)00200-6[Crossref]
  • [12] Prause G., Ratzenhofer-Comenda B., Pierer G., Smolle-Jüttner F., Glanzer H., Smolle J., Can ASA grade or Goldman’s cardiac risk index predict perioperative mortality? A study of 16,227 patients, Anaesthesia, 1997, 52(3), 203–206 http://dx.doi.org/10.1111/j.1365-2044.1997.074-az0074.x[Crossref]
  • [13] Gilbert K., Larocque B.J., Patrick L.T., Prospective evaluation of cardiac risk indices for patients undergoing noncardiac surgery, Ann. Intern. Med., 2000, 133, 356–359
  • [14] Devereaux P.J, Goldman L., Yusuf S., Gilbert K., Leslie K., Guyatt G.H., Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review, CMAJ, 2005, 173(7), 779–788
  • [15] Polanczyk C.A., Goldman L., Marcantonio E.R., Orav E.J., Lee T.H., Supraventricular arrhythmia in patients having noncardiac surgery: clinical correlates and effect on length of stay, Ann. Intern. Med., 1998, 129(4), 279–285
  • [16] Goldman L., Supraventricular tachyarrhythmias in hospitalized adults after surgery, Clinical correlates in patients over 40 years of age after major noncardiac surgery, Chest, 1978, 73(4), 450–454 http://dx.doi.org/10.1378/chest.73.4.450[Crossref]
  • [17] Rinfret S., Goldman L., Polanczyk C.A., Cook E.F., Lee T.H., Value of immediate postoperative electrocardiogram to update risk stratification after major noncardiac surgery, Am. J. Cardiol., 2004, 94(8), 1017–1022 http://dx.doi.org/10.1016/j.amjcard.2004.06.057[Crossref]
  • [18] Lopez-Jimenez F., Goldman L., Sacks D.B., Thomas E.J., Johnson P.A., Cook E.F., et al. Prognostic value of cardiac troponin T after noncardiac surgery: 6-month follow up data, J. Am. Coll. Cardiol. 1997, 29(6), 1241–1245 http://dx.doi.org/10.1016/S0735-1097(97)82754-4
  • [19] Goldman L., Caldera D.L., Southwick F.S., Cardiac risk factors and complications in non-cardiac surgery, Medicine (Baltimore), 1978, 57, 357–370 http://dx.doi.org/10.1097/00005792-197807000-00006[Crossref]
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  • [28] Sugarbaker D.J., Donaldson M.C., Goldman L., Simple index for prediction of cardiac risk in stable patients undergoing major noncardiac surgery: what about the more severely compromised patients? Response, Circulation, 2000, 102(15), e106
  • [29] Cohn S.L., Goldman L., Preoperative risk evaluation and perioperative management of patients with coronary disease, Med. Clin. North. Am., 2003, 87(1), 111–136 http://dx.doi.org/10.1016/S0025-7125(02)00143-8[Crossref]
  • [30] Fleishman K.E., Goldman L., Young B., Lee TH., Association between cardiac and noncardiac complications in patients undergoing noncardiac surgery: outcomes and effects on length of stay, Am. J. Med., 2003, 115–120
  • [31] Auerbach A., Goldman L., Assessing and reducing the cardiac risk of noncardiac surgery, Circulation, 2006,113(10),1361–1376 http://dx.doi.org/10.1161/CIRCULATIONAHA.105.573113[Crossref]

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