Prediction of perioperative myocardial infarction/injury in high-risk patients after noncardiac surgery

Figures

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  Figure 1. Patient flow chart. Study population selection can be seen in this flow chart. Missing laboratory values included missing preoperative routinely available laboratory values, as well as missing preoperative hs-cTnT or s-cTnI values. PMI, perioperative myocardial infarction/injury; hs-cTnT, high-sensitivity cardiac troponin T; s-cTnI, sensitive cardiac troponin I.

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  Figure 2. Accuracy for the prediction of perioperative myocardial infarction/injury. Area under the receiver operating characteristic curve to compare the diagnostic accuracy of Model 3 with the RCRI, the ASA classification, and hs-cTnT alone (A). Area under the receiver operating characteristic curve quantifying the accuracy of the three prediction models in the derivation cohort (B). AUC, area under the receiver operating characteristic curve; RCRI, revised cardiac risk index; ASA, American Society of Anesthesiologists.

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  Figure 3. Examples for usage of the online calculator tool. A patient with age of 70 years, normal weight, no history of coronary artery disease or myocardial infarction, metabolic equivalent of task > 4, intermediate risk of surgery according to the European Society of Cardiology, elective surgery, planned duration of surgery of 100 min, no anaemia, normal level of thrombocytes, and a high-sensitivity cardiac troponin T of 3 ng/L has a risk of perioperative myocardial infarction/injury of 1.6% (A). A patient with age of 75 years, underweight, history of coronary artery disease without myocardial infarction, metabolic equivalent of task < 4, intermediate risk of surgery according to the European Society of Cardiology, elective surgery, planned duration of surgery of 150 min, mild-to-moderate anaemia, normal level of thrombocytes, and a high-sensitivity cardiac troponin T of 12 ng/L has a risk of perioperative myocardial infarction/injury of 20.7% (B). A patient with age of 80 years, overweight, history of coronary artery disease with myocardial infarction, metabolic equivalent of task < 4, high risk of surgery according to the European Society of Cardiology, urgent surgery <24 h, planned…

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  Figure 4. Recalibration cohort. Comparison of Model 3 with the revised cardiac risk index and the American Society of Anesthesiologists classification for the prediction of perioperative myocardial infarction/injury in the recalibration cohort (A). Comparison of the area under the receiver operating characteristic curve of the three prediction models to perioperative myocardial infarction/injury in the recalibration cohort (B). RCRI, revised cardiac risk index; ASA, American Society of Anesthesiologists; PMI, perioperative myocardial infarction/injury; AUC, area under the receiver operating characteristic curve.