biostudies-literatureUnknown14Nasrallah AA<h4>Introduction</h4>Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index.<h4>Methods</h4>The cohort was derived from the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction, stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer-Lemeshow test and compared to the RCRI and the AUB-HAS2 index.<h4>Results</h4>In a cohort of 4795 patients, MACE occurred in 52 (1.1%) patients. A univariate analysis yielded 13 eligible variables for entry into the multivariate model. The final PN-A₄CH model utilized six variables: <b>A</b>ge ⩾75 years, <b>A</b>SA class >2, <b>A</b>nemia, surgical <b>A</b>pproach, <b>C</b>reatinine >1.5, and history of <b>H</b>eart disease. Index ROC analysis provided a C-statistic of 0.81, calibration <i>R</i> ² was 0.99, and sensitivity was 85%. In comparison, the RCRI and AUB-HAS2 C-statistics were 0.59 and 0.68, respectively.<h4>Conclusion</h4>This study proposes a novel procedure-specific cardiovascular risk index. The PN-A₄CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection.Therapeutic advances in urology17562872221084847https://www.ebi.ac.uk/biostudies/studies/S-EPMC8935558biostudies-literatureMajor adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index.PMC8935558Najdi JAAbou Heidar NFDakik HAMansour MNasrallah OGHajj AENasrallah AATamim HfalseMajor adverse cardiovascular events following partial nephrectomy: a procedure-specific risk index.<h4>Introduction</h4>Partial nephrectomy (PN) is associated with a non-negligible risk of postoperative cardiovascular morbidity and mortality. Identification of high-risk patients may enable optimization of perioperative management and consideration of alternative approaches. The authors aim to develop a procedure-specific cardiovascular risk index for PN patients and compare its performance to the widely used revised cardiac risk index (RCRI) and AUB-HAS2 cardiovascular risk index.<h4>Methods</h4>The cohort was derived from the American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome was the incidence of major adverse cardiovascular events (MACE), defined as 30-day postoperative incidence of myocardial infarction, stroke, or mortality. A multivariate logistic regression model was constructed; performance and calibration were evaluated using an ROC analysis and the Hosmer-Lemeshow test and compared to the RCRI and the AUB-HAS2 index.<h4>Results</h4>In a cohort of 4795 patients, MACE occurred in 52 (1.1%) patients. A univariate analysis yielded 13 eligible variables for entry into the multivariate model. The final PN-A₄CH model utilized six variables: <b>A</b>ge ⩾75 years, <b>A</b>SA class >2, <b>A</b>nemia, surgical <b>A</b>pproach, <b>C</b>reatinine >1.5, and history of <b>H</b>eart disease. Index ROC analysis provided a C-statistic of 0.81, calibration <i>R</i> ² was 0.99, and sensitivity was 85%. In comparison, the RCRI and AUB-HAS2 C-statistics were 0.59 and 0.68, respectively.<h4>Conclusion</h4>This study proposes a novel procedure-specific cardiovascular risk index. The PN-A₄CH index demonstrated good predictive ability and excellent calibration using a large national database and may enable further individualization of patient care and optimization of patient selection.2022-01-01T00:00:00Z2022 Jan-Dec2025-04-04T14:50:14.781Z2025-04-04T14:50:14.781ZS-EPMC89355583532105210.1177/17562872221084847