Detsky Modified Cardiac Risk Index

Predicts risk of cardiovascular complications in patients undergoing noncardiac surgery.

There are instructions on how to interpret the result provided and about the predictor variables, in the text below the calculator.


The Detsky modified cardiac risk index assesses the likelihood of cardiovascular complications in patients who are about to undergo noncardiac surgery.

The score is based on patient parameters that have independent predictive value for cardiovascular events, such as presence of arrhythmia, suspected critical aortic stenosis or unstable angina.


According to this modified Destky index, the patients are categorised as either at high, moderate or low risk of cardiovascular events:

Score Risk of cardiovascular events
Above 30 High
Between 16 and 30 Moderate
Below 16 Low

1

Age

2

Prior myocardial infarction

3

Unstable angina in the last 6 months

4

Angina pectoris

5

Alveolar pulmonary edema

6

Suspected critical aortic stenosis

7

Arrhythmia

8

Emergency surgery

9

General medical status

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About Detsky modified score

This is a model aimed at revealing the degree of cardiovascular risk in the periopeative setting in the case of patients who have relevant cardiac risk factors. The index consists of 9 items, all with differing predictive value:

Destky modified cardiac risk item Answer choices (points)
Age 70 and below (0)
Above 70 (5)
Prior myocardial infarction No (0)
Within the last 6 months (10)
More than 6 months ago (5)
Unstable angina in the last 6 months No (0)
Yes (10)
Angina pectoris No (0)
Class III angina (10)
Class IV angina (20)
Alveolar pulmonary edema Never (0)
In the last week (10)
Ever (5)
Suspected critical aortic stenosis No (0)
Yes (20)
Arrhythmia Sinus or sinus with PACs (0)
Other than sinus or sinus with PACs (5)
More than 5 premature ventricular beats (5)
Emergency surgery* No (0)
Yes (10)
General medical status Normal (0)
Poor (5)

* Emergency surgery is considered to carry a higher risk than elective surgery, also because of the large fluid shifts and blood loss.

In contrast to the original Detsky cardiac risk index, the modified version adds new variables (e.g. angina and pulmonary edema), changes the allocation of points and contains a slightly different interpretation (the three risk groups).

Since the score is addressed to patient preparing to undergo minor or major noncardiac surgery, it is useful to offer examples of both types:

■ Vascular, head and neck, orthopedic, intra-thoracic and intraperitoneal surgery class as major;

■ Cataract or prostate procedures class as minor.

 

Score interpretation

The nine items in the modified Destky index are awarded a number of points (varying from 0 to 20), depending on their predictive value. The final score is then included in one of the following cardiovascular risk groups:

■ High risk: scores >30;

■ Moderate risk: scores between 16 and 30;

■ Low risk: scores <16.

 

Perioperative cardiac risk

The cardiovascular risk factors that are to be taken in consideration before patients undergo cardiac or noncardiac, major or minor surgery, are divided in three risk categories, according to their importance:

Type of cardiovascular risk factor Examples of conditions
Major Recent myocardial infarction;
Severe unstable angina;
Decompensated chronic heart failure;
Severe valvular disease;
AV block arrhythmias;
Moderate Prior myocardial infarction;
Mild angina;
Compensated or prior chronic heart failure;
Renal insufficiency;
Diabetes mellitus;
Low Evidence of abnormal ECG;
Abnormal rhythm;
History of stroke;
Uncompensated hypertension;
Advanced age;

The American College of Cardiology (ACC) and the American Heart Association (AHA) provide guidelines in regard to preoperative cardiovascular evaluation.

 

References

1. 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.

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. 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.


App Version: 1.0.1

Coded By: MDApp

Specialty: Cardiology

System: Cardiovascular

Objective: Risk Prediction

Type: Index

No. Of Items: 9

Article By: Denise Nedea

Published On: August 20, 2017 · 08:55 AM

Last Checked: August 20, 2017

Next Review: August 20, 2018