November 1, 2017Journal of the American Heart AssociationOpen Access

Derivation and Validation of a Geriatric‐Sensitive Perioperative Cardiac Risk Index

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Perioperative cardiac risk in noncardiac surgery (n=1070357). Intervention: Geriatric-Sensitive Cardiac Risk Index (GSCRI) vs. Revised Cardiac Risk Index (RCRI) and Gupta MICA calculator. Primary outcome: Myocardial Infarction or Cardiac Arrest (MICA) prediction (AUC 0.76 for GSCRI vs 0.63 for RCRI and 0.70 for Gupta MICA (Δ AUC 0.13 and 0.06), p=<0.001).

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Key result

The Geriatric-Sensitive Cardiac Risk Index (GSCRI) outperformed the RCRI and Gupta MICA models in predicting perioperative cardiac risk in patients ≥65 years (AUC 0.76 vs 0.63 and 0.70; P<0.001).

Why the study?

Does the Geriatric-Sensitive Cardiac Risk Index (GSCRI) improve the prediction of perioperative myocardial infarction or cardiac arrest compared to the RCRI and Gupta MICA models in geriatric patients undergoing noncardiac surgery?

Population

1,070,357 surgical patients from the NSQIP database, including 383,819 geriatric patients undergoing…

Comparison

Geriatric-Sensitive Cardiac Risk Index (GSCRI) vs Revised Cardiac Risk Index and Gupta Myocardial…

Design

Cohort

Follow-up

perioperative

Authors

RARami Alrezk NJNicholas JacksonUniversity of California, Los Angeles MRMohanad Al Rezk

Discussion

Member takes

Implication

May refine perioperative risk stratification in older adults; hypothesis-generating pending prospective validation.

Study Design

Type

Cohort (n=1,070,357)

Multicenter

Yes

Structured PICO

Population

1,070,357 surgical patients (383,819 aged ≥65) from the NSQIP 2012 and 2013 cohorts, used to derive and validate a geriatric-sensitive perioperative cardiac risk index.

Exposure

Geriatric-Sensitive Cardiac Risk Index (GSCRI)

Comparator

Revised Cardiac Risk Index (RCRI) and Gupta Myocardial Infarction or Cardiac Arrest (MICA) calculator

Outcome

Area under the curve (AUC) for predicting perioperative myocardial infarction or cardiac arrest (MICA)hard clinical

Main Result

Effect estimate: AUC 0.76 for GSCRI vs 0.63 for RCRI and 0.70 for Gupta MICA (Δ AUC 0.13 and 0.06)

p-value: p=<0.001

The newly derived Geriatric-Sensitive Cardiac Risk Index (GSCRI) significantly outperforms existing models (RCRI and Gupta MICA) in predicting perioperative cardiac complications in patients aged 65 and older undergoing noncardiac surgery.

Cite This Study

Alrezk et al. (2017) conducted a cohort in Perioperative cardiac risk in noncardiac surgery (n=1,070,357). Geriatric-Sensitive Cardiac Risk Index (GSCRI) vs. Revised Cardiac Risk Index (RCRI) and Gupta MICA calculator was evaluated on Myocardial Infarction or Cardiac Arrest (MICA) prediction (AUC 0.76 for GSCRI vs 0.63 for RCRI and 0.70 for Gupta MICA (Δ AUC 0.13 and 0.06), p=<0.001). The Geriatric-Sensitive Cardiac Risk Index (GSCRI) outperformed the RCRI and Gupta MICA models in predicting perioperative cardiac risk in patients ≥65 years (AUC 0.76 vs 0.63 and 0.70; P<0.001).

synapsesocial.com/papers/6aa2243453a31ffc17d3cda8 https://doi.org/10.1161/jaha.117.006648

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Derivation and Validation of a Geriatric‐Sensitive Perioperative Cardiac Risk Index

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Derivation and Validation of a Geriatric‐Sensitive Perioperative Cardiac Risk Index

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider