OBJECTIVE To conduct a systematic review of published cardiac risk indices relevant to patients undergoing noncardiac surgery and to provide clinically meaningful recommendations to physicians regarding the use of these indices. METHODS A literature search of articles published from January 1, 1999, through December 28, 2018, was conducted in Ovid (MEDLINE), PubMed, Embase, CINAHL, and Web of Science. Publications describing models predicting risk of cardiac complications after noncardiac surgery were included and citation chaining was used to identify additional studies for inclusion. RESULTS Eleven risk indices involving 2,910,297 adult patients were included in this analysis. Studies varied in size, population, quality, risk of bias, outcome event definitions, risk factors identified, index outputs, accuracy, and clinical usefulness. Studies considered 6 to 83 variables to develop their models. Among the identified models, the factors with the highest predictiveness for adverse cardiac outcomes included congestive heart failure, type of surgery, creatinine, diabetes, history of stroke or transient ischemic attack, and emergency surgery. Substantial data from the large studies also supports advancing age, American Society of Anesthesiology physical status classification, functional status, and hypertension as additional risks. CONCLUSION The risk indices identified generally fell into two groups - those with higher accuracy for predicting a narrow range of cardiac outcomes and those with lower accuracy for predicting a broader range of cardiac outcomes. Using one index from each group may be the most clinically useful approach. Risk factors identified varied widely among studies. In addition to judicious use of predictive indices, reasoned clinical judgment remains indispensable in assessing perioperative cardiac risk.

中文翻译：

---

检查风险：围手术期心脏风险预测指标的系统评价。

目的对已发表的与非心脏手术患者有关的心脏风险指数进行系统的回顾，并就这些指数的使用向医生提供具有临床意义的建议。方法在Ovid（MEDLINE），PubMed，Embase，CINAHL和Web of Science中对1999年1月1日至2018年12月28日发表的文章进行文献检索。包括描述非心脏手术后预测心脏并发症风险的模型的出版物，并使用引文链接确定其他纳入研究。结果该分析包括11项涉及2,910,297名成年患者的风险指数。研究的规模，人群，质量，偏倚风险，结果事件定义，确定的风险因素，指标输出，准确性和临床实用性各不相同。研究考虑了6到83个变量来建立他们的模型。在确定的模型中，对心脏不良后果具有最高预测性的因素包括充血性心力衰竭，手术类型，肌酐，糖尿病，中风或短暂性脑缺血发作的历史以及急诊手术。来自大型研究的大量数据还支持年龄的增长，美国麻醉医师学会的身体状况分类，功能状况和高血压等其他风险。结论所确定的风险指数通常分为两类-较高的准确度可预测狭窄的心脏预后，而较低的准确度可预测广泛的心脏预后。在每个组中使用一个指标可能是临床上最有用的方法。在研究中发现的危险因素差异很大。除了明智地使用预测指标外，在评估围手术期心脏风险中，合理的临床判断仍然是必不可少的。