Cardiac scoring systems--what is their value?

Estimating the peri-operative risk of major adverse cardiac events is one of the functions of cardiac risk scoring systems. Fortunately, peri-operative cardiac complications are relatively infrequent in most patients. Clinical algorithms use sequential screening tests to detect patients most at risk of cardiac complications. However, because the sensitivity and specificity of the tests used are low, the predictive performance of the commonly-used cardiac screening tests may not be completely satisfactory. The purpose of this review is to describe measures of performance of cardiac screening tests and illustrate their potential benefits and weaknesses.