A postoperative dynamic nomogram incorporating age, preoperative hemoglobin, hs-cTnT, and Surgical Apgar Score significantly improved the prediction of MINS compared to the RCRI (AUC 0.853 vs 0.541).
Cohort (n=358)
No
Does a postoperative dynamic nomogram accurately predict myocardial injury after noncardiac surgery in high-risk patients undergoing colorectal cancer resection?
A postoperative dynamic nomogram using age, preoperative hemoglobin, hs-cTnT, and Surgical Apgar Score accurately predicts the risk of myocardial injury after noncardiac surgery in high-risk colorectal cancer patients.
Absolute Event Rate: 0.853% vs 0.541%
p-value: p=<0.001
Abstract Background Myocardial injury after noncardiac surgery (MINS) is closely associated with perioperative cardiovascular events and is a critical complication leading to poor prognosis. This study aimed to develop a nomogram model to predict the risk of MINS in high-risk patients undergoing colorectal cancer surgery, which can be applied immediately after surgery to guide postoperative troponin monitoring and individualized intervention. Methods This study retrospectively included 358 patients at high cardiovascular risk who underwent laparoscopic colorectal cancer surgery from August 2021 to January 2023. They were assigned randomly to training and validation cohorts in a 7:3 ratio. After univariate analysis and multicollinearity assessment, multivariable logistic regression identified independent predictors associated with MINS in the training cohort, and nomogram prediction models were constructed. The nomogram model’s discrimination, calibration, and clinical validity in the training and validation cohorts were evaluated and validated. Results Age, preoperative hemoglobin, preoperative high-sensitivity troponin T (hs‑cTnT), and the Surgical Apgar Score (SAS) were identified as independent predictors. The AUC (C‑index) of the nomogram constructed from these four predictors was 0.884 (95% CI: 0.831–0.937) and 0.853 (95% CI: 0.729–0.977) in the training and validation cohorts, respectively. Decision curve analysis indicated favorable clinical utility, with a positive net benefit across a wide range of threshold probabilities including the recommended 20% risk threshold. Conclusion A postoperative dynamic nomogram based on preoperative and intraoperative variables provides a simple, practical tool for predicting MINS risk in high-risk patients undergoing colorectal cancer surgery. The model showed favorable discriminative ability and calibration upon internal validation, but prospective external validation is needed before clinical implementation. Trial registration The study was registered with the Chinese Clinical Trial Registry (ChiCTR2200065961, 20/11/2022).
Li et al. (Wed,) conducted a cohort in Myocardial injury after noncardiac surgery (MINS) (n=358). Postoperative dynamic nomogram vs. Revised Cardiac Risk Index (RCRI) was evaluated on Prediction of MINS event within the first three postoperative days (AUC) (95% CI 0.729-0.977, p=<0.001). A postoperative dynamic nomogram incorporating age, preoperative hemoglobin, hs-cTnT, and Surgical Apgar Score significantly improved the prediction of MINS compared to the RCRI (AUC 0.853 vs 0.541).