Preoperative clinical model to predict myocardial injury after non-cardiac surgery: a retrospective analysis from the MANAGE cohort in a Spanish hospital

Abstract

ObjectivesTo determine preoperative factors associated to myocardial injury after non-cardiac surgery (MINS) and to develop a prediction model of MINS.DesignRetrospective analysis.SettingTertiary hospital in Spain.ParticipantsPatients aged ≥45 years undergoing major non-cardiac surgery and with at least two measures of troponin levels within the first 3 days of the postoperative period. All patients were screened for the MANAGE trial.Primary and secondary outcome measuresWe used multivariable logistic regression analysis to study risk factors associated with MINS and created a score predicting the preoperative risk for MINS and a nomogram to facilitate bed-side use. We used Least Absolute Shrinkage and Selection Operator method to choose the factors included in the predictive model with MINS as dependent variable. The predictive ability of the model was evaluated. Discrimination was assessed with the area under the receiver operating characteristic curve (AUC) and calibration was visually assessed using calibration plots representing deciles of predicted probability of MINS against the observed rate in each risk group and the calibration-in-the-large (CITL) and the calibration slope. We created a nomogram to facilitate obtaining risk estimates for patients at pre-anaesthesia evaluation.ResultsOur cohort included 3633 patients recruited from 9 September 2014 to 17 July 2017. The incidence of MINS was 9%. Preoperative risk factors that increased the risk of MINS were age, American Status Anaesthesiology classification and vascular surgery. The predictive model showed good performance in terms of discrimination (AUC=0.720; 95% CI: 0.69 to 0.75) and calibration slope=1.043 (95% CI: 0.90 to 1.18) and CITL=0.00 (95% CI: −0.12 to 0.12).ConclusionsOur predictive model based on routinely preoperative information is highly affordable and might be a useful tool to identify moderate-high risk patients before surgery. However, external validation is needed before implementation.

Intraoperative Variables Enhance the Predictive Performance of Myocardial Injury in Patients with High Cardiovascular Risk After Thoracic Surgery When Added to Baseline Prediction Model

“…In a preoperative clinical model to predict myocardial injury with a large sample size, age, vascular surgery, and ASA scores III and IV were identified as three independent preoperative predictors of MINS. 2 Compared with our experiment, the most significant difference may be due to the study population and the type of operation. We included people with high cardiovascular risk, and thoracic surgery has a special physiological state, which explains why our model included new risk factors.…”

“…1 It is estimated that one out of every seven surgical patients over 45 years old with an increased risk of perioperative cardiovascular (CV) events suffered from MINS. 2 In the largest cohort study of cardiovascular events in patients undergoing non-cardiac surgery (VISION), the incidence of MINS after thoracic surgery was 19.8%. 3 Troponin increased during the perioperative period is an essential indicator of poor prognosis in patients, which will increase the risk of death within 30 days after surgery and is independently related to the increase in mortality.…”

Natriuretic Peptides and Troponins to Predict Cardiovascular Events in Patients Undergoing Major Non-Cardiac Surgery

“…Only the most recent studies used hs-cTnI and hs-cTnT methods to detect MINS [34,37,40,41,88,91]. The most important characteristics of experimental design and clinical results of the studies using hs-cTnI (one study) and hs-cTnT (five studies) are summarized in Table 3.…”

“…The most important characteristics of experimental design and clinical results of the studies using hs-cTnI (one study) and hs-cTnT (five studies) are summarized in Table 3. In two retrospective studies, the incidence of MINS was 9% in a study from Spain using hs-cTnI [41], and 3.5% in another study from the USA using hs-cTnT [91]. The other four studies [34,37,40,88] aimed to estimate the association between hs-cTnT and perioperative cardiovascular risk.…”

Assessment and Correction of the Cardiac Complications Risk in Non-cardiac Operations – What's New?

“…В когорте больных исследования MANAGE в Испании выявили предоперационные факторы, ассоциированные с повреждением миокарда после некардиальных операций (ПМНО): возраст, класс по ASA и операция на сосудах [18]. Среди всех больных исследования MANAGE (35 815 пациентов) проведена оценка частоты сердечных осложнений, включая ПМНО, по классам риска RCRI.…”