Objective: Pre-operative cardiovascular risk assessment using defined risk indices helps estimate adverse post-operative outcomes and mortality. The available data does not support a single best approach, especially for elderly patients. We aimed to reveal the relationship of cardiac risk indices used pre-operatively with in-hospital mortality and intensive care unit (ICU) admission, with the goal of contributing to a more practical and effective assessment strategy for this growing population.
Materials and
Methods: This retrospective single-center study analyzed 503 patients aged over 65 who were assessed preoperatively by cardiology for cardiac risk stratification between June 2023 and June 2024. We assessed the relationship between three cardiac risk indices – cardiologist-determined risk, revised cardiac risk index (RCRI), and geriatric cardiac risk index (GSCRI) – with in-hospital mortality and ICU admission.

Results: A cardiologist’s risk assessment revealed no significant ability to predict mortality, with an area under the curve (AUC) of 0.564. In contrast, both the RCRI and the GSCRI showed significant predictive ability, each with an AUC of 0.677. All three cardiac risk indices demonstrated significant effectiveness in distinguishing patients who may require admission to the ICU.

Conclusion: Pre-operative evaluation of the elderly with GSCRI could guide a perioperative patient management plan and predict prognosis, without an overuse of cardiac consultation.