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Comparative Study
. 2020 May 18;9(10):e016228.
doi: 10.1161/JAHA.119.016228. Epub 2020 May 10.

AUB-HAS2 Cardiovascular Risk Index: Performance in Surgical Subpopulations and Comparison to the Revised Cardiac Risk Index

Habib A Dakik  1 , Eman Sbaity  2 , Ahmad Msheik  1 , Chris Kaspar  1 , Mahmoud Eldirani  1 , Omar Chehab  1 , Ossama Abou Hassan  1 , Aurelie Mailhac  3 , Maha Makki  3 , Hani Tamim  3
Affiliations
Comparative Study

AUB-HAS2 Cardiovascular Risk Index: Performance in Surgical Subpopulations and Comparison to the Revised Cardiac Risk Index

Habib A Dakik et al. J Am Heart Assoc. .

Abstract

Background The American University of Beirut (AUB)-HAS2 Cardiovascular Risk Index is a newly derived index for preoperative cardiovascular evaluation. It is based on 6 data elements: history of heart disease; symptoms of angina or dyspnea; age ≥75 years; hemoglobin <12 mg/dL; vascular surgery; and emergency surgery. In this study we analyze the performance of this new index and compare it with that of the Revised Cardiac Risk Index in a broad spectrum of surgical subpopulations. Methods and Results The study population consisted of 1 167 278 noncardiac surgeries registered in the American College of Surgeons National Surgical Quality Improvement Program database. Each patient was given an AUB-HAS2 score of 0, 1, 2, 3, or >3, depending on the number of data elements present. The performance of the AUB-HAS2 index was studied in 9 surgical specialty groups and in 8 commonly performed site-specific surgeries. Receiver operating characteristic curves were constructed for the AUB-HAS2 and Revised Cardiac Risk Index measures, and the areas under the curve were compared. The outcome measure was death, myocardial infarction, or stroke at 30 days after surgery. The AUB-HAS2 score was able to stratify risk in all surgical subgroups (P<0.001). In the majority of surgeries, patients with an AUB-HAS2 score of 0 had an event rate of <0.5%. The performance of the AUB-HAS2 index was superior to that of the Revised Cardiac Risk Index in all surgical subgroups (P<0.001). Conclusions This study extends the validation of the AUB-HAS2 index to a broad spectrum of surgical subpopulations and demonstrates its superior discriminatory power compared with the commonly utilized Revised Cardiac Risk Index.

Keywords: AUB‐HAS2 cardiovascular risk index; preoperative cardiovascular evaluation; revised cardiac risk index.

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Figures

Figure 1
Figure 1. The AUB‐HAS2 index.
AUB indicates American University of Beirut. The HAS2 is an acronym of the data elements as illustrated in the figure.
Figure 2
Figure 2. Bar graph comparing the 30‐day event rates (death, myocardial infarction, or stroke) among the different AUB‐HAS2 score groups within each specialty (A) and each site‐specific surgery (B) (P value for trend <0.001 in all subgroups). AUB indicates American University of Beirut.
Figure 3
Figure 3. Comparison of the receiver operating characteristic (ROC) curves of the AUB‐HAS2 index and the Revised Cardiac Risk Index (RCRI) in the overall study population.
AUB indicates American University of Beirut; AUC, area under the curve (P<0.001 for AUB‐HAS2 vs RCRI).
See this image and copyright information in PMC

References

    1. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, Davila‐Roman VG, Gerhard‐Herman MD, Holly TA, Kane GC, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing non cardiac surgery. A report of the American college of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130:2215–2245. - PubMed
    1. Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, Ford I, Gonzalez‐Juanatey JR, Gorenek B, Heyndrickx GR, et al. 2014 ESC/ESA guidelines on non‐cardiac surgery: cardiovascular assessment and management: the Joint Task Force on non‐cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anesthesiology (ESA). Eur Heart J. 2014;35:2383–2431. - PubMed
    1. Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major non‐cardiac surgery. N Engl J Med. 2015;373:2258–2269. - PubMed
    1. Dakik HA, Kobrossi S, Tamim H. The yield of routine pre‐operative cardiovascular evaluation in stable patients scheduled for elective non‐cardiac surgery. Int J Cardiol. 2015;186:325–327. - PubMed
    1. Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major non‐cardiac surgery. Circulation. 1999;100:1043–1049. - PubMed

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