Perioperative Cardiac Risk Prediction in Non Cardiac Surgery-Investigation for Efficiency of Nuclear Scanning(Medical System)

非心臓手術中に発生する心事故リスクの推定を行った．これまで事故推定が難しいとされてきた，中，低リスク手術を含む1351 の手術記録から，何らかの心事故が発生した「全心事故」および，心臓死もしくは心筋梗塞の「hard event」の発生について解析した．解析因子には，手術の難易度，患者の年齢や既往歴などの臨床ファクタおよび，核医学検査結果に分類できる合計22 の項目を用い，予測モデルには線形および，サポートベクターマシン（SVM）識別器を用いた．交差検定法において，全心事故では，感度 80％，特異度 66％，hard event では，感度 85％，特異度 81％の，従来報告されているより良好な推定精度を実現した．線形，SVM識別器双方ともに，核医学検査で得られる共通のパラメータが選択されており，心臓事故の術前推定が難しい，中，低リスク手術においても核医学検査結果が重要な因子であることが確認できた．

[1]  B R Chaitman,et al.  Determination of perioperative cardiac risk by adenosine thallium-201 myocardial imaging. , 1992, American heart journal.

[2]  E F Cook,et al.  Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. , 1999, Circulation.

[3]  B. Everitt,et al.  Applied Multivariate Data Analysis. , 1993 .

[4]  Gordon H. Guyatt,et al.  Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk , 2005, Canadian Medical Association Journal.

[5]  L J Shaw,et al.  Meta-analysis of intravenous dipyridamole-thallium-201 imaging (1985 to 1994) and dobutamine echocardiography (1991 to 1994) for risk stratification before vascular surgery. , 1996, Journal of the American College of Cardiology.

[6]  K Gilbert,et al.  Prospective Evaluation of Cardiac Risk Indices for Patients Undergoing Noncardiac Surgery , 2000, Annals of Internal Medicine.

[7]  Jingming Bai,et al.  Influence of ageing on perioperative cardiac risk in non-cardiac surgery. , 2006, Age and ageing.

[8]  T. Marwick,et al.  Outcomes and cost implications of a clinical-based algorithm to guide the discriminate use of stress imaging before noncardiac surgery. , 1997, American heart journal.

[9]  E. Antman,et al.  ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery---executive summary a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluat , 2002, Circulation.

[10]  P. Lapuerta,et al.  Neural Network Assessment of Perioperative Cardiac Risk in Vascular Surgery Patients , 1998, Medical decision making : an international journal of the Society for Medical Decision Making.

[11]  K A Eagle,et al.  Development and validation of a Bayesian model for perioperative cardiac risk assessment in a cohort of 1,081 vascular surgical candidates. , 1996, Journal of the American College of Cardiology.