Chehab Omar, Eldirani Mahmoud, Tamim Hani, Mailhac Aurelie, Makki Maha, Dakik Habib A
Departments of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon.
Perioper Med (Lond). 2022 Jun 2;11(1):23. doi: 10.1186/s13741-022-00247-2.
The AUB-HAS2 Cardiovascular Risk Index is a recently published tool for pre-operative cardiovascular evaluation. It is based on six data elements: history of heart disease, symptoms of angina or dyspnea, age ≥ 75 years, hemoglobin < 12 mg/dl, vascular surgery, and emergency surgery. The objective of this study is to study the effect of age and gender on the performance of the AUB-HAS2 Index in pre-operative cardiovascular risk assessment.
The study population consisted of 1,167,414 non-cardiac surgeries registered in the ACS NSQIP database. The population was stratified by age (≥ 40 and < 40 years old) and by gender (men and women). Each patient was given an AUB-HAS2 score of 0, 1, 2, 3, or > 3 based on the number of data elements s/he has. The outcome measure was all-cause mortality, myocardial infarction (MI), or stroke at 30 days after surgery.
The overall 30-day event rate was higher in patients ≥ 40 years compared to those < 40 years (2.5% vs 0.3%, P < 0.0001) and in men compared to women (2.7% vs 1.8%, P < 0.0001). In both age and gender subgroups, there was a gradual and significant increase in the outcome measure (death, MI, or stroke) as the AUB-HAS2 score increased: from ≤ 0.5% in those with a score of 0 to more than 15% in those with a score > 3 (P < 0.0001). The AUB-HAS2 Index was able to stratify risk in all subgroups into low, intermediate, and high (P < 0.0001). Receiver operating characteristic curves showed the AUB-HAS2 Index has very good discriminatory power in both age (area under the curve (AUC) of 0.81 and 0.78) and gender (AUCs of 0.79 and 0.84) subgroups.
This study extends the validation of the newly derived AUB-HAS2 Cardiovascular Risk Index to different age and gender subgroups with very good discriminative power.
AUB-HAS2心血管风险指数是最近发布的一种术前心血管评估工具。它基于六个数据元素：心脏病史、心绞痛或呼吸困难症状、年龄≥75岁、血红蛋白<12mg/dl、血管手术和急诊手术。本研究的目的是探讨年龄和性别对AUB-HAS2指数在术前心血管风险评估中性能的影响。
研究人群包括美国外科医师学会国家外科质量改进计划（ACS NSQIP）数据库中登记的1167414例非心脏手术患者。根据年龄（≥40岁和<40岁）和性别（男性和女性）对人群进行分层。根据每个患者拥有的数据元素数量，给予其AUB-HAS2评分为0、1、2、3或>3。观察指标为术后30天的全因死亡率、心肌梗死（MI）或中风。
≥40岁患者的30天总体事件发生率高于<40岁患者（2.5%对0.3%，P<0.0001），男性高于女性（2.7%对1.8%，P<0.0001）。在年龄和性别亚组中，随着AUB-HAS2评分的增加，观察指标（死亡、MI或中风）均逐渐显著增加：评分为0的患者中≤0.5%，评分>3的患者中超过15%（P<0.0001）。AUB-HAS2指数能够将所有亚组的风险分层为低、中、高风险（P<0.0001）。受试者工作特征曲线显示，AUB-HAS2指数在年龄亚组（曲线下面积（AUC）分别为0.81和0.78）和性别亚组（AUC分别为0.79和0.84）中均具有很好的鉴别能力。
本研究将新推导的AUB-HAS2心血管风险指数的验证扩展到不同年龄和性别亚组，具有很好的鉴别能力。
