Preoperative assessment of cardiovascular risk in patients undergoing noncardiac surgery: the Orion study

Submitted: September 17, 2019
Accepted: November 4, 2019
Published: February 6, 2020
Abstract Views: 1897
PDF: 985
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


In patients undergoing noncardiac surgery risk indices can estimate patients’ perioperative risk of major cardiovascular complications. The indexes currently in use were derived from observational studies that are now outdated with respect to the current clinical context. We undertook a prospective, observational, cohort study to derive, validate, and compare a new risk index with established risk indices. We evaluated 7335 patients (mean age 63±13 years) who underwent noncardiac surgery. Based on prospective data analysis of 4600 patients (derivation cohort) we developed an Updated Cardiac Risk Score (UCRS), and validated the risk score on 2735 patients (validation cohort). Four variables (i.e. the UCRS) were significantly associated with the risk of a major perioperative cardiovascular events: high-risk surgery, preoperative estimate glomerular filtration rate <30 ml/min/1.73 m2, age ≥75 years, and history of heart failure. Based on the UCRS we created risk classes 1,2,3 and 4 and their corresponding 30-day risk of a major cardiovascular complication was 0.8% [95% confidence interval (CI) 0.5-1.7], 2.5 (95% CI 1.6-5.6), 8.7 (95% CI 5.2-18.9) and 27.2 (95% CI 11.8-50.3), respectively. No significant differences were found between the derivation and validation cohorts. Receiver operating characteristic (ROC) curves demonstrate a high predictive performance of the new index, with greater power to discriminate between the various classes of risk than the indexes currently used. The high predictive performance and simplicity of the UCRS make it suitable for wide-scale use in preoperative cardiac risk assessment of patients undergoing noncardiac surgery.



PlumX Metrics


Download data is not yet available.


How to Cite

Scorcu, Giampaolo, Annarita Pilleri, Paolo Contu, Pompilio Faggiano, Roberto Floris, Alessandra Mereu, Luisella Pistis, Roberto Sessego, Luigi Valentino, and Claudia Sardu. 2020. “Preoperative Assessment of Cardiovascular Risk in Patients Undergoing Noncardiac Surgery: The Orion Study”. Monaldi Archives for Chest Disease 90 (1).

Similar Articles

You may also start an advanced similarity search for this article.