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Myocardial Infarction in Neonatal Mice, A Model of Cardiac Regeneration
Published on: May 24, 2016
External validation of the Revised Cardiac Risk Index and National Surgical Quality Improvement Program Myocardial
J Fronczek1, K Polok1, P J Devereaux2
1Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland.
Insights
The National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) calculator and Revised Cardiac Risk Index (RCRI) showed limited accuracy for predicting cardiac events in noncardiac surgery patients. Recalibration is needed for these risk prediction tools.
Area of Science:
- Cardiology
- Perioperative Medicine
- Surgical Outcomes
Background:
- Established risk indices like the NSQIP MICA calculator and RCRI were developed using outdated methods for diagnosing perioperative myocardial infarctions.
- This study evaluates the external validity of these tools in a contemporary setting with systematic perioperative cardiac biomarker measurement.
Purpose of the Study:
- To assess the predictive performance of the NSQIP MICA calculator and RCRI in identifying major cardiac complications after noncardiac surgery.
- To determine the clinical utility of these risk prediction models in a real-world, at-risk patient population.
Main Methods:
- Analysis of routinely collected data from the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation Study.
- Inclusion of consecutive patients aged ≥45 undergoing in-hospital noncardiac surgery.
- Measurement of high-sensitivity troponin T at multiple time points and diagnosis of myocardial infarction per the Third Universal Definition.
Main Results:
- The study included 870 patients (80.9% male, median age 65 years).
- Major cardiac complications occurred in 8.7% of patients.
- The NSQIP MICA demonstrated a c-statistic of 0.64, and the RCRI had a c-statistic of 0.60, with both models systematically underestimating predicted risks (P<0.001).
Conclusions:
- The NSQIP MICA calculator and RCRI exhibit limited predictive performance in this at-risk surgical population.
- The recently updated RCRI demonstrated improved reliability compared to its original version, suggesting potential for enhanced clinical utility after recalibration.
Background:
The National Surgical Quality Improvement Program Myocardial Infarction & Cardiac Arrest (NSQIP MICA) calculator and the Revised Cardiac Risk Index (RCRI) were derived using currently outdated methods of diagnosing perioperative myocardial infarctions. We tested the external validity of these tools in a setting of a systematic perioperative cardiac biomarker measurement.
Methods:
Analysis of routinely collected data nested in the Vascular Events In Noncardiac Surgery Patients Cohort Evaluation Study. A consecutive sample of patients ≥45 yr old undergoing in-hospital noncardiac surgery in a single tertiary care centre was enrolled. The predictive performance of the models was tested in terms of the occurrence of major cardiac complications defined as a composite of a nonfatal myocardial infarction, a nonfatal cardiac arrest, or a cardiac death within 30 days after surgery. The plasma concentration of high-sensitivity troponin T was measured before surgery, 6-12 h after operation, and on the first, second, and third days after surgery. Myocardial infarction was diagnosed according to the Third Universal Definition.
Results:
The median age was 65 (59-72) yr, and 704/870 (80.9%) subjects were male. The primary outcome occurred in 76/870 (8.7%; 95% confidence interval [CI], 6.9-10.8%) patients. The c-statistic was 0.64 (95% CI, 0.57-0.70) for the NSQIP MICA and 0.60 (95% CI, 0.54-0.65) for the RCRI. Predicted risks were systematically underestimated in calibration belts (P<0.001). The RCRI and the NSQIP MICA showed no clinical utility before recalibration.
Conclusions:
The NSQIP and RCRI models had limited predictive performance in this at-risk population. The recently updated version of the RCRI was more reliable than the original index.
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