Key result
Three perioperative risk models disagree ~29% of the time on low-risk MACE classification.
Why the study?
Do the Revised Cardiac Index, ACS NSQIP Surgical Risk Calculator, and MICA calculator agree on classifying patients as low risk for MACE prior to noncardiac surgery?
Population
10,000 patient records scheduled to undergo noncardiac surgery
Comparison
Risk stratification using the American College… vs Risk stratification using the Revised Cardiac…
Design
Cohort
Authors
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Model disagreement on low-risk classification warrants caution in perioperative decisions; challenges model interchangeability and leaves optimal tool selection open.
Observational (n=10,000)
Do the Revised Cardiac Index, ACS NSQIP Surgical Risk Calculator, and MICA calculator agree on classifying patients as low risk for MACE prior to noncardiac surgery?
Effect estimate: ICC 0.68 (ACS NSQIP vs MICA) (95% CI 0.66 to 0.70)
There is wide variability among the Revised Cardiac Index, ACS NSQIP, and MICA calculators in predicting low cardiac risk for noncardiac surgery, which could lead to differences in clinical decision-making.
Glance et al. (2018) conducted an observational in Patients scheduled to undergo noncardiac surgery (n=10,000). Risk-prediction tools (Revised Cardiac Index, ACS NSQIP Surgical Risk Calculator, MICA calculator) vs. Each other was evaluated on Agreement between three risk-prediction tools on the classification of patients as low risk (<1%) of major adverse cardiac event (ICC 0.68 (ACS NSQIP vs MICA), 95% CI 0.66 to 0.70). The three perioperative risk-prediction models (Revised Cardiac Index, ACS NSQIP, and MICA) disagreed 29% of the time on which patients were classified as low risk for major adverse cardiac events.
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