Application of predicting risk of cardiovascular disease events equations on postoperative major adverse cardiac and cerebral events for patients undergoing thoracic surgery

Objectives The American Heart Association's Predicting Risk of Cardiovascular Disease Events (PREVENT) equations predict cardiovascular risk, but their utility in perioperative settings is unclear. This study aims to evaluate the association between PREVENT equations and postoperative cardiovascular events in thoracic surgical population. Methods This retrospective study included 1,073 patients undergoing thoracic surgery at Nanfang Hospital, Southern Medical University, between January 2019 and October 2023. The sex-specific PREVENT risk scores for atherosclerotic cardiovascular disease (ASCVD), coronary heart disease (CHD), heart failure (HF), and total cardiovascular disease (CVD) were calculated. The study outcome was 30-day postoperative composite events of major adverse cardiac and cerebral events (MACCE: composite of angina, myocardial injury, stroke, and HF). The single event or composition combinations matched to PREVENT risk scores were also assessed: angina, HF, angina or myocardial injury (AMI), AMI or stroke (AMIS). Multivariate logistic regression was used to evaluate MACCE risk, with false discovery rate (FDR) correction for P values. The discriminative ability was assessed using receiver operating characteristic (ROC) curves and area under the curve (AUC). Results The median age of included patients was 58 years old. In females, one standard-deviation (SD) increase in the ASCVD score was significantly associated with higher odds of postoperative angina (OR = 1.95, 95% CI: 1.19–3.21, FDR corrected P = 0.0381). CHD score was significantly associated with female angina (OR = 1.83, 95% CI: 1.14–2.95, FDR corrected P = 0.0354) and AMI (OR = 1.46, 95% CI: 1.05–2.03, FDR corrected P = 0.0386). In males, no PREVENT risk scores were significantly associated with major adverse cardiac and cerebral events (all FDR corrected P 0.05). The PREVENT equations demonstrated light to moderate discrimination, with AUCs ranging from 0.65 to 0.75 in female patients. Conclusions The PREVENT equations demonstrated preliminary associations with 30-day postoperative MACCE in non-cardiac thoracic surgical female patients, but not in male patients.