Detsky Cardiac Risk Index

About the cardiac risk index

This index provides a standardized cardiac assessment for cardiovascular risk, to be administered to patients who are about to undergo major or minor noncardiac surgery. Because in this case risk is highly influenced by underlying cardiac conditions, their existence or that of relevant risk factors is checked.

Common underlying cardiovascular diseases that may pose risks in noncardiac surgeries include:

■ Peripheral artery disease;

■ Atherosclerosis;

■ Stroke;

■ Coronary artery disease.

The earlier the identification of patients who are stratified in high risk groups, the better patient management can be put in place, along with analysis of the benefits and drawbacks of surgery.

The following table introduces the eight items taken in consideration and their associated number of points.

Detsky’s cardiac index can guide perioperative evaluation and improve the management of heart failure and myocardial infarction risk in patients with known cardiovascular risk factors.

Criticism of the study is based on the fact that there are several important criteria that have not been included, like:

■ History or presence of atrial fibrillation;

■ Obsesity;

■ Diabetes mellitus;

■ History of cerebrovascular disease.

Current medical guidelines state that the use of a preoperative risk assessment is compulsory, to avoid overlooking any undiagnosed conditions. In some cases, this may lead to delaying surgery until a complete set of laboratory tests is returned.

Result interpretation

Each of the 8 items in the Detsky cardiac risk index is weighted according to its individual predictive value.

The sum of points awarded to each item, as described in the previous section, makes the total score, which ranges between 0 and 85.

The higher the score, the greater the cardiovascular risk.

Patients diagnosed with unstable angina, decompensated heart failure, high grade arrhythmias or who suffered recently from myocardial infarction are likely to score close to 85.

The 4 risk classes linked to the Detsky scores and their associated risk of complications in percentage, can be found in the table below:

About the study

The 1986 study by Detsky et al. involved a cohort of 455 consecutive patients that have been referred to the general medical consultation service for cardiac risk assessment prior to non-cardiac surgery. Data was used to test a previous version of a cardiac risk index and generate a revised index that reflected risk factors considered important.

Both versions of the index had good statistic performance, however the previous index performed less well than in the original study. Both indices predicted cardiovascular risk in patients undergoing minor or major surgery.

It is important for clinicians to estimate local overall complication rates (pretest probabilities) before applying data from the study.

Original source

Detsky AS, Abrams HB, McLaughlin JR, Drucker DJ, Sasson Z, Johnston N, Scott JG, Forbath N, Hilliard JR. Predicting cardiac complications in patients undergoing non-cardiac surgery. J Gen Intern Med. 1986; 1(4):211-9.

Other references

1. Goldman L, Caldera DL, Nussbaum SR, Southwick FS, Krogstad D, Murray B, Burke DS, O'Malley TA, Goroll AH, Caplan CH, Nolan J, Carabello B, Slater EE. Multifactorial index of cardiac risk in noncardiac surgical procedures. N Engl J Med. 1977; 297(16):845-50.

2. Detsky AS, Abrams HB, Forbath N, Scott JG, Hilliard JR. Cardiac assessment for patients undergoing noncardiac surgery. A multifactorial clinical risk index. Arch Intern Med. 1986; 146(11):2131-4.

3. Schouten O, Bax J, Poldermans D. Assessment of cardiac risk before non‐cardiac general surgery. Heart. 2006; 92(12): 1866–1872.