Cardiology Consultation in Noncardiac Surgery
Condition: Myocardial Infarction; Surgery-Complications
MeSH terms: Myocardial Infarction; Infarction
Study type: Observational [Patient Registry]

Summary: 
      Recently, a predictive model has been developed to assess the risk of myocardial infarction
      or cardiac arrest (MICA) during and after surgery using the American Society of Surgeons'
      National Surgical Quality Improvement Program (NSQIP) database. In this MICA model, 180
      hospital databases were used in 2007 and 2008 and included more than 200 000 patients. The
      Gupta score developed with this MICA model identified five predictors of perioperative
      myocardial infarction and cardiac arrest: type of surgery, functional status, creatinine
      increase (>130 mmol/L or >1.5 mg/dL), age, and American Association of Anesthesiologists
      (ASA) class. The Gupta score is presented as an interactive risk calculation program in the
      2014 guideline of the ACC/AHA. The risk can be calculated simply and accurately at the
      bedside or clinic. The Gupta score is in spreadsheet format and can be downloaded online at
      http://www.surgicalriskcalculator.com/miorcardiacarrest. Unlike the previously used indexes,
      a scoring system has not been established. An estimate of the probability of myocardial
      infarction/cardiac arrest is provided for individual patients.

      In this study, the primary aim was to compare the frequency of cardiology consultation
      requests according to the use of the Gupta score. The secondary aim is to evaluate the
      perioperative clinical results (coronary angiography, ECHO, acute coronary syndrome,
      arrhythmia, 30-day mortality, etc.).SPSS 21.0 (Version 22.0, SPSS, Inc, Chicago, IL, USA)
      program will be used for statistical analysis. After applying the Shapiro-Wilk test for
      normality, the student's t-test will be used if the distribution is normal, and the
      Mann-Whitey U test will be used if the distribution is not normal. Fisher's exact test or
      chi-square test will be used for categorical variables. Results p<0.05 will be considered
      significant.
    

Detailed description: 
      All patients undergoing non-cardiac surgery are at risk of major perioperative cardiovascular
      events. Cardiac complications account for 42% of the overall complications of these
      surgeries. Therefore, cardiologists are the most frequently consulted specialists in
      preoperative evaluation. Unnecessary cardiology consultations may cause comments that will
      not affect the practice of anesthesia, inappropriate tests and interventions, and delay in
      the surgical procedure.

      Recently, a predictive model has been developed to assess the risk of myocardial infarction
      or cardiac arrest (MICA) during and after surgery using the American Society of Surgeons'
      National Surgical Quality Improvement Program (NSQIP) database. In this MICA model, 180
      hospital databases were used in 2007 and 2008 and included more than 200 000 patients. The
      Gupta score developed with this MICA model identified five predictors of perioperative
      myocardial infarction and cardiac arrest: type of surgery, functional status, creatinine
      increase (>130 mmol/L or >1.5 mg/dL), age, and American Association of Anesthesiologists
      (ASA) class. The Gupta score is presented as an interactive risk calculation program in the
      2014 guideline of the ACC/AHA. The risk can be calculated simply and accurately at the
      bedside or clinic. The Gupta score is in spreadsheet format and can be downloaded online at
      http://www.surgicalriskcalculator.com/miorcardiacarrest. Unlike the previously used indexes,
      a scoring system has not been established. An estimate of the probability of myocardial
      infarction/cardiac arrest is provided for individual patients.
    

Intervention name(s): Gupta score
Intervention type(s): Other
Intervention description(s): The Gupta score is presented as an interactive risk calculation program in the 2014 guideline of the ACC/AHA. The Gupta score developed with this MICA model identified five predictors of perioperative myocardial infarction and cardiac arrest: type of surgery, functional status, creatinine increase (>130 mmol/L or >1.5 mg/dL), age, and American Association of Anesthesiologists (ASA) class. The frequency of cardiology consultation requests will be investigated according to the use of the Gupta score.
Observational model: Other
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Patients over the age of 18 who will be referred to the anesthesia polyclinic and will
        undergo non-cardiac surgery will be included in the study. Cardiology consultation will be
        requested from these patients according to the Gupta score. Additional tests or
        examinations may be requested if the cardiologist deems it necessary.
      
Keywords: ACC/AHA guidelines; Perioperative cardiac risk; Cardiology consultation