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Performance of the AUB-HAS2 Cardiovascular Risk Index in vascular surgery patients
Ahmad Msheik1, Chris Kaspar1, Aurelie Mailhac2
1Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Insights
The modified American University of Beirut (AUB)-HAS2 risk index effectively stratifies patients undergoing vascular surgery. This tool predicts low, intermediate, and high risks for cardiovascular events, aiding preoperative evaluation.
Area of Science:
- Cardiovascular Surgery
- Surgical Risk Assessment
- Health Services Research
Background:
- The American University of Beirut (AUB)-HAS2 risk index is a validated tool for preoperative cardiovascular risk assessment.
- Existing risk indices may not fully capture the complexities of vascular surgery patients.
- A modified AUB-HAS2 index, excluding vascular surgery as a factor, warrants evaluation in diverse vascular procedures.
Purpose of the Study:
- To analyze the performance of a modified AUB-HAS2 risk index in predicting 30-day adverse cardiovascular outcomes (death, myocardial infarction, stroke) across a wide range of vascular surgery types.
- To assess the index's ability to stratify risk into low, intermediate, and high categories for vascular surgery patients.
Main Methods:
- A retrospective analysis of 90,476 vascular surgery cases from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.
- The modified AUB-HAS2 index, comprising history of heart disease, cardiac symptoms, age ≥ 75, anemia, and emergency surgery, was applied.
- Performance was evaluated across seven vascular surgery groups: carotid endarterectomy (CEA), open abdominal aortic aneurysm repair (OAAA), endovascular aortic aneurysm repair, supra-inguinal bypass, infra-inguinal bypass, lower extremity thrombo-endarterectomy, and lower extremity angioplasty.
Main Results:
- The modified AUB-HAS2 index successfully stratified risk in most patients into low (<3%), intermediate (3-10%), and high (>10%) categories (p < 0.0001).
- The overall area under the receiver operating characteristic curve (AUC) was 0.71, indicating good discriminative ability.
- AUC values ranged from 0.60 for CEA to 0.75 for OAAA, demonstrating consistent performance across different vascular procedures.
Conclusions:
- The modified AUB-HAS2 index is a simple and effective tool for preoperative risk stratification in patients undergoing a broad spectrum of vascular surgeries.
- Its ability to categorize patients into distinct risk groups aids in clinical decision-making and resource allocation.
- The index provides valuable insights into predicting major adverse cardiovascular events within 30 days post-vascular surgery.
Abstract:
The American University of Beirut (AUB)-HAS2 risk index is a recently published tool for preoperative cardiovascular evaluation. It is based on six data elements: history of Heart disease, symptoms of Heart disease (angina or dyspnea), Age ⩾ 75 years, Anemia (hemoglobin < 12 mg/dL), emergency Surgery, and vascular Surgery. This study analyzes the performance of a modified AUB-HAS2 index (excluding the vascular surgery element) in a broad spectrum of vascular surgery procedures. The study population consisted of 90,476 vascular surgeries registered in the American College of Surgeons National Surgical Quality Improvement Program database. The performance of the AUB-HAS2 index was studied in seven groups: carotid endarterectomy (CEA), open abdominal aortic aneurysm surgical repair (OAAA), endovascular aortic aneurysm repair, supra-inguinal bypass, infra-inguinal bypass, lower extremity thrombo-endarterectomy, and lower extremity angioplasty. The outcome measure was death, myocardial infarction, or stroke at 30 days after surgery. Each patient was given an AUB-HAS2 score of 0, 1, 2, or > 2 depending on the number of data elements s/he has. The AUB-HAS2 index was able to stratify risk in the majority of patients into low (< 3%, score 0), intermediate (3-10%, score 1-2), and high (> 10%, score > 2) (p < 0.0001). The receiver operating curve had an area of 0.71 in the overall group and it ranged from 0.60 in CEA patients to 0.75 in OAAA patients. In conclusion, the AUB-HAS2 index is a simple tool that can quickly and effectively stratify the risk of patients undergoing a broad spectrum of vascular surgeries into low, intermediate, and high.
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