Acurácia dos escores de avaliação pré-operatória do risco cirúrgico cardiovascular em cirurgias não cardíacas eletivas: revisão sistemática

Abstract

Noncardiac surgeries are responsible for most of surgical procedures. Perioperative cardiovascular complications are important cause of morbity and mortality between these patients. The evaluation of preoperative cardiac risk , through use of scores, is fundamentally important in the attempt to reduce the risk of events or their consequences. Objective: To assess the accuracy of cardiovascular risk preoperative evaluation scores in elective noncardiac surgeries, as well as to compare the performance of different scores each other and in relation to other risk assessment tests. Methods: This is a systematic review of the literature. Search was done on online database MEDLINE/PubMed, SCOPUS, SciELO e LILACS, according PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Initially the selection of articles was based on the titles that matched the main topic; then, we read their abstracts. After reading selected abstratcs, inclusion criteria for final selection and integral reading were: assessment of cardiovascular risk scores’ performance in preoperative evaluation in elective noncardiac surgeries, original articles with free access and measurement of intra hospital and/or 30 days cardiovascular outcomes. Results/Discussion: 19 articles were included, of which 18 articles and one doctoral thesis. The articles analyzed risk scores individually and associated with other diagnosis tools, as biomarkers and cardiac imaging tests. All of the studies were observational, 60% of them were retrospective. The sample size was greatly variable and part of the studies assessed the accuracy of preoperative cardiovascular risk scores as secondary objective. The RCRI score was the most used and evaluated and, in general, showed satisfactory accuracy on the prediction of postoperative cardiovascular outcomes, in different types of noncardiac surgery and in different contexts of patient profiles. Among the new predictors under assessment, NT-proBNP biomarker had prominence as promisor strategy to discriminate patients in major risk of cardiovascular events in post operatory of noncardiac surgery, but still lacks definitive validation. The formal utility of biomarkers should be singly assessed or in combination with risk scores already used in clinical practice. Conclusion: The RCRI score was the best performing algorithm. Biomarkers have also been tested in predicting cardiac risk, especially natriuretic peptides, which appear to perform well in isolation and potential to improve the accuracy of validated scores, such as RCRI itself.