Performance of the AUB-HAS2 cardiovascular risk index in coronary artery disease: a multicenter retrospective cohort...

While the American University of Beirut (AUB)-HAS2 cardiovascular risk index has emerged as a novel tool for preoperative risk stratification, its performance specifically in coronary artery disease (CAD) patients warrants further validation. This study aimed to evaluate the performance of AUB-HAS2 index specifically in CAD patients.

In this multicenter retrospective cohort study, we enrolled consecutive adult patients with documented CAD who underwent non-cardiac surgery between 2013 and 2024 at two tertiary academic medical centers in Zhejiang, China. The primary outcome was a composite of perioperative cardiovascular events (PCE), including all-cause death, myocardial infarction, or stroke, occurring intraoperatively or during postoperative hospitalization.

Among 10,294 participants, 374 (3.6%) experienced PCEs. The incidence of PCEs increased steadily with the increase in AUB-HAS2 index (0.3%, 2.3%, 5.2%, 10.1%, and 21.7% for AUB-HAS2 index of 0, 1, 2, 3, and > 3, respectively; p value for trend < 0.001). The AUB-HAS2 index showed significantly better discrimination than the revised cardiac risk index (RCRI) (C-statistic: 0.765 vs. 0.689; p < 0.001), with consistent performance across subgroups and better calibration. Decision curve analysis revealed enhanced clinical utility across clinically relevant thresholds.

The AUB-HAS2 index demonstrates improved predictive performance compared to the RCRI in CAD patients, supporting its clinical adoption for preoperative cardiovascular risk stratification in this high-risk population.