A comparison of four risk models for the prediction of cardiovascular complications in patients with a history of atrial fibrillation undergoing non-cardiac surgery
Por:
McAlister, FA, Youngson, E, Jacka, M, Graham, M, Conen, D, Chan, M, Szczeklik, W, Alonso-Coello, P, Devereaux, PJ, Vasc Events Non-Cardiac Surg Patle
Publicada:
1 ene 2020
Ahead of Print:
1 jul 2019
Resumen:
It is unclear how best to predict peri-operative cardiovascular risk in patients with atrial fibrillation undergoing non-cardiac surgery. This study examined the accuracy of the revised cardiac risk index and three atrial fibrillation thrombo-embolic risk models for predicting 30-day cardiovascular events after non-cardiac surgery in patients with a pre-operative history of atrial fibrillation. We conducted a prospective cohort study in 28 centres from 2007 to 2013 of 40,004 patients >= 45 years of age undergoing inpatient non-cardiac surgery who were followed until 30 days after surgery for cardiovascular events (defined as myocardial injury, heart failure, stroke, resuscitated cardiac arrest or cardiovascular death). The 2088 patients with a pre-operative history of atrial fibrillation were at higher risk of peri-operative cardiovascular events compared with the 34,830 patients without a history of atrial fibrillation (29% vs. 13%, respectively, adjusted odds ratio 1.30 (95%CI 1.17-1.45). Compared with the revised cardiac risk index (c-index 0.60), all atrial fibrillation thrombo-embolic risk scores were significantly better at predicting peri-operative cardiovascular events: CHADS(2) (c-index 0.62); CHA(2)DS(2)-VASc (c-index 0.63); and R(2)CHADS(2) (c-index 0.65), respectively. Although the three thrombo-embolic risk prediction models were significantly better than the revised cardiac risk index for prediction of peri-operative cardiovascular events, none of the four models exhibited strong discrimination metrics. There remains a need to develop a better peri-operative risk prediction model.
Filiaciones:
McAlister, FA:
Univ Alberta, Alberta SPOR Support Unit, Data Platform, Edmonton, AB, Canada
Univ Alberta, Dept Med, Gen Internal Med, Edmonton, AB, Canada
Youngson, E:
Univ Alberta, Alberta SPOR Support Unit, Data Platform, Edmonton, AB, Canada
Jacka, M:
Univ Alberta, Dept Med, Crit Care Med, Edmonton, AB, Canada
Graham, M:
Univ Alberta, Dept Med, Cardiol, Edmonton, AB, Canada
Conen, D:
McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
Chan, M:
Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Hong Kong, Peoples R China
Szczeklik, W:
Jagiellonian Univ, Med Coll, Dept Intens Care & Perioperat Med, Krakow, Poland
Alonso-Coello, P:
CIBER Epidemiol & Salud Publ CIBERES, Biomed Res Inst Sant Pau IIB Sant Pau, Iberoamer Cochrane Ctr, Barcelona, Spain
Devereaux, PJ:
McMaster Univ, Populat Hlth Res Inst, Hamilton, ON, Canada
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