Key result
The AUB-HAS2 cardiovascular risk index showed significantly better discrimination for perioperative cardiovascular events than the revised cardiac risk index (C-statistic: 0.765 vs. 0.689; p<0.001).
Why the study?
Does the AUB-HAS2 cardiovascular risk index improve preoperative cardiovascular risk stratification compared to the revised cardiac risk index (RCRI) in adult patients with coronary artery disease undergoing non-cardiac surgery?
Cohort (n=10,294)
Yes
Does the AUB-HAS2 cardiovascular risk index improve preoperative cardiovascular risk stratification compared to the revised cardiac risk index (RCRI) in adult patients with coronary artery disease undergoing non-cardiac surgery?
The AUB-HAS2 cardiovascular risk index provides superior discrimination compared to the standard RCRI for predicting perioperative cardiovascular events in CAD patients undergoing non-cardiac surgery.
Hypothesis-generating for AUB-HAS2 superiority over RCRI in preoperative CAD risk stratification; leaves open adoption pending prospective validation.
Background 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.Methods 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.Results 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.Conclusions 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.
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Li et al. (2026) conducted a cohort in Coronary artery disease (CAD) (n=10,294). AUB-HAS2 cardiovascular risk index vs. Revised cardiac risk index (RCRI) was evaluated on Composite of perioperative cardiovascular events (PCE), including all-cause death, myocardial infarction, or stroke (C-statistic 0.765 vs 0.689, p=< 0.001). The AUB-HAS2 cardiovascular risk index showed significantly better discrimination for perioperative cardiovascular events than the revised cardiac risk index (C-statistic: 0.765 vs. 0.689; p<0.001).
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