1. Oncology Institute of Vojvodina Department of anaesthesiology and intensive care Institutski put 4, 21204 Sremska Kamenica, SERBIA www.onk.ns.ac.yu dsakic@eunet.rs Evaluation of different cardiac risk indices for patients undergoing noncardiac surgery Dragana Radovanovic, Radmila Kolak, Aleksandar Stokic, Gordana Jovanovic Introduction: ASA NYHA the modified Detsky risk indexACC/AHA Anaesthesiologists will be confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity, and prediction of cardiac complications is important in the medical management of patients. Several indices have been developed to predict cardiac complications and to identify patients which are at risk for cardiac complications. The aim of the present study was to determine the incidence of perioperative cardiac complications and to compare the accuracy of four indices currently used for predicting perioperative complications (ASA (American Society of Anesthesiologist Classification System), NYHA (New York Heart Association Classification System), the modified Detsky risk index and ACC/AHA (The American College of Cardiology/The American Hearth Association Guidelines)). Materials and Method: A total of 100 patients with cardiac diseases undergoing noncardiac surgery were enrolled in this prospective study (Group A 50 patients undergoing intraperitoneal surgery and Group B 50 patients undergoing breast and thyroid surgery). Predictive factors for perioperative cardiac complications were assessed through clinical history, physical examination and from preoperative testing, cardiac risk were evaluated and all patients were classified according to four indices of cardiac risk. The patients were followed up during the perioperative period and after surgery until leaving hospital to assess the occurrence of all cardiac events. Major cardiac events included myocardial infarction, unstable angina, acute pulmonary oedema and death. To determine and compare the accuracy of different systems of stratification for each index we used Spearman’s rank correlation test and regression analysis. Results: Cardiac complications (systemic arterial hypertension, systemic arterial hypotension, abnormalities of cardiac conduction and cardiac rhythm, perioperative myocardial ischemia and acute myocardial infarction) occurred in 64% of the patients. One of the 100 patients (1%) had had major cardiac event (postoperative myocardial infarction which was fatal). All of the indices studied showed a statistically significant degree in cardiac risk assessment (p<0.01 for all comparisons). Although all indices predicted cardiac risk with high accuracy, the modified Detsky risk index was significantly superior (CI 95%, coefficient ß=0,48). Factors independently associated with incidence of cardiac complications included type of surgical procedure, advanced age, duration of anaesthesia and surgery, abnormal preoperative electrocardiogram, abnormal preoperative chest radiography and diabetes. Conclusion:  Cardiac risk indices are reliable, objective and valid method of assessing cardiac risk in patients who undergo elective non cardiac surgery.  All indices predicted cardiac risk with high accuracy, the modified Detsky risk index was significantly superior Oncology Institute of Vojvodina Department of anaesthesiology and intensive care Institutski put 4, 21204 Sremska Kamenica, SERBIA www.onk.ns.ac.yu dsakic@eunet.rs