Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
J Am Coll Cardiol. 2019 Jun 25;73(24):3067-3078. doi: 10.1016/j.jacc.2019.04.023.
Currently used indices for pre-operative cardiovascular evaluation are either powerful, but complex, or simple, but with weak discriminatory power.
This study sought to prospectively derive and validate a simple powerful index that can stratify the cardiovascular risk of patients undergoing noncardiac surgery.
The derivation cohort consisted of 3,284 prospectively enrolled adult patients undergoing noncardiac surgery at the American University of Beirut Medical Center. The validation cohort consisted of 1,167,414 patients registered in the American College of Surgeons National Surgical Quality Improvement Program database. The primary outcome measure was death, myocardial infarction, or stroke at 30 days after surgery.
The primary outcome occurred in 38 patients (1.2%) in the derivation cohort. Multivariate logistic regression analysis in the derivation cohort identified 6 data elements to be included in the prediction model: age ≥75 years, history of heart disease, symptoms of angina or dyspnea, hemoglobin <12 mg/dl, vascular surgery, and emergency surgery. Each patient was assigned a Cardiovascular Risk Index (CVRI) of 0, 1, 2, 3, and >3 based on the number of data elements present. The incidence of the primary outcome increased steadily across the CVRI groups in both the derivation (0%, 0.5%, 2.0%, 5.6%, and 15.7%, respectively; p < 0.0001) and validation (0.3%, 1.6%, 5.6%, 11.0%, and 17.5%, respectively; p < 0.0001) cohorts. The discriminatory power of the new CVRI was further confirmed by constructing a receiver-operating characteristic curve that had an area under the curve of 0.90 in the derivation cohort and 0.82 in the validation dataset.
This study reports a new index for pre-operative cardiovascular evaluation which has a strong discriminatory power that can effectively stratify patients into low- (CVRI 0 to 1), intermediate- (CVRI 2 to 3), and high-risk (CVRI >3) groups. This has important implications for the efficient triage and management of patients scheduled for noncardiac surgery.
目前用于术前心血管评估的指标要么功能强大，但复杂，要么简单，但区分能力弱。
本研究旨在前瞻性地得出并验证一种简单而强大的指数，以分层接受非心脏手术的患者的心血管风险。
该研究的推导队列包括 3284 名在贝鲁特美国大学医学中心接受非心脏手术的前瞻性纳入的成年患者。验证队列包括在美国外科医师学会国家手术质量改进计划数据库中登记的 1167414 名患者。主要观察指标是术后 30 天内死亡、心肌梗死或中风。
推导队列中有 38 名患者（1.2%）发生主要结局。推导队列中的多变量逻辑回归分析确定了纳入预测模型的 6 个数据元素：年龄≥75 岁、心脏病史、心绞痛或呼吸困难症状、血红蛋白<12mg/dl、血管手术和急诊手术。根据存在的数据元素的数量，每位患者被分配心血管风险指数（CVRI）为 0、1、2、3 和>3。在推导队列中，主要结局的发生率在 CVRI 组中稳步上升（分别为 0%、0.5%、2.0%、5.6%和 15.7%；p<0.0001）和验证队列（分别为 0.3%、1.6%、5.6%、11.0%和 17.5%；p<0.0001）。通过构建受试者工作特征曲线进一步证实了新的 CVRI 的判别能力，该曲线在推导队列中的曲线下面积为 0.90，在验证数据集的曲线下面积为 0.82。
本研究报告了一种新的术前心血管评估指数，该指数具有较强的判别能力，可有效将患者分为低危（CVRI 0 至 1）、中危（CVRI 2 至 3）和高危（CVRI>3）组。这对非心脏手术患者的有效分诊和管理具有重要意义。
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