CHADS2 best predictor of postoperative mortality risk
Finlay A. McAlister, M.D., from the University of Alberta in Edmonton, Canada, and colleagues assessed the accuracy of AF thromboembolic risk models (the CHADS2, CHA2DS2-VASc, and R2CHADS2 scores) versus the Revised Cardiac Risk Index (RCRI) among an international cohort of patients (≥45 years of age) undergoing inpatient, non-cardiac surgery with 30 days of post-surgery follow-up.
The researchers found that the 961 patients with preoperative AF were at higher risk for any cardiovascular event in the postoperative period compared with the 13,001 patients without AF (26.6 versus 9 percent, respectively; adjusted odds ratio, 1.58). All thromboembolic risk scores predicted postoperative death as well as the RCRI. The CHADS2 significantly improved postoperative stroke/mortality risk prediction compared to the RCRI, largely because of improved discrimination of patients who did not subsequently have an event.
"In AF patients, the three thromboembolic risk scores performed similarly to the RCRI in predicting death within 30 days and the CHADS2 score was the best predictor of postoperative stroke/death regardless of type of surgery," the authors write.
One author disclosed financial ties to medical device and pharmaceutical companies.
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