Combining CHA2DS2-VASc score into RCRI for prediction perioperative cardiovascular outcomes in patients undergoing non-cardiac surgery: a retrospective pilot study

Chu, Song-Yun; Li, Pei-Wen; Fan, Fang-Fang; Han, Xiao-Ning; Liu, Lin; Wang, Jie; Zhao, Jing; Ye, Xiao-Jin; Ding, Wen-Hui

doi:10.1186/s12871-021-01496-2

Table 2 Assessment of the RCRI, CHA₂DS₂-VASc and the combination as predictor for perioperative cardiovascular events

From: Combining CHA₂DS₂-VASc score into RCRI for prediction perioperative cardiovascular outcomes in patients undergoing non-cardiac surgery: a retrospective pilot study

Variable	C-statistic (95% CI)	Sensitivity	Specificity	X² (P value) ^b	PPV	NPV	NRI (95% CI)
Composite endpoints
RCRI	0.668(0.610–0.725)	0.470	0.848	0.0001(1.000)	0.76	0.62	1 [Reference]
CHA₂DS₂-VASc	0.765(0.709–0.820), P^a = 0.011*	0.783	0.621	4.996(0.758)	0.67	0.74	0.308(0.172–0.445), P^a < 0.001*
CHA₂DS₂-VASc +RCRI	0.774(0.719–0.829), P^a < 0.001*	0.542	0.879	4.315(0.828)	0.82	0.66	0.308(0.172–0.445), P^a < 0.001*
Myocardial infarction
RCRI	0.678(0.595–0.760)	0.500	0.836	0.025(1.000)	0.75	0.63	1 [Reference]
CHA₂DS₂-VASc	0.775(0.706–0.844), P^a = 0.028*	0.800	0.604	7.563(0.477)	0.67	0.75	0.506(0.275–0.737), P^a < 0.001*
CHA₂DS₂-VASc +RCRI	0.791(0.725–0.857), P^a = 0.003*	0.750	0.674	5.329(0.722)	0.70	0.73	0.501(0.313–0.688), P^a < 0.001*
Cardiac ischemic events
RCRI	0.698(0.627–0.770)	0.539	0.842	0.261(1.000)	0.77	0.65	1 [Reference]
CHA₂DS₂-VASc	0.779(0.716–0.841), P^a = 0.030*	0.808	0.610	5.833 (0.666)	0.67	0.76	0.278(0.123–0.433), P^a < 0.001*
CHA₂DS₂-VASc +RCRI	0.792(0.732–0.853), P^a = 0.002*	0.673	0.772	3.604(0.891)	0.75	0.70	0.324(0.192–0.455), P^a < 0.001*
Atrial fibrillation
RCRI	0.617(0.501–0.732)	0.250	0.972	1.203(0.997)	0.90	0.56	1 [Reference]
CHA₂DS₂-VASc	0.802(0.701–0.902), P^a = 0.012*	0.800	0.701	6.260(0.618)	0.73	0.78	0.593 (0.297–0.889), p^a < 0.001*
CHA₂DS₂-VASc +RCRI	0.833(0.739–0.927), P^a < 0.001*	0.800	0.752	3.882(0.868)	0.76	0.79	0.593 (0.297–0.889), P^a < 0.001*
Heart failure
RCRI	0.668(0.548–0.789)	0.500	0.832	0.436(0.999)	0.75	0.62	1 [Reference]
CHA₂DS₂-VASc	0.727(0.593–0.861), p^a = 0.411	0.667	0.698	1.452(0.994)	0.69	0.68	0.315 (−0.016–0.646), P^a = 0.062
CHA₂DS₂-VASc +RCRI	0.743(0.623–0.863), P^a = 0.188	0.722	0.655	0.429(1.000)	0.68	0.70	0.315(−0.016–0.646), p^a = 0.062
Stroke
RCRI	0.678(0.379–0.978)	0.500	0.827	0.019(1.000)	0.74	0.62	1 [Reference]
CHA₂DS₂-VASc	0.924(0.832–1.000), P^a = 0.039*	1.000	0.694	1.848(0.985)	0.77	1.00	0.431 (−0.059–0.922), p^a = 0.085
CHA₂DS₂-VASc +RCRI	0.952(0.894–1.000), P^a = 0.048*	1.000	0.786	2.876(0.942)	0.82	1.00	0.487(−0.003–0.977), P^a = 0.052
All-cause death
RCRI	0.623(0.530–0.717)	0.400	0.830	0.005(1.000)	0.70	0.58	1 [Reference]
CHA₂DS₂-VASc	0.676(0.578–0.775), P^a = 0.076	0.667	0.626	1.702(0.989)	0.64	0.65	0.414(0.365–0.463), P^a < 0.001*
CHA₂DS₂-VASc +RCRI	0.719(0.621–0.817), P^a = 0.015*	0.433	0.884	0.427(1.000)	0.79	0.61	0.390(0.344–0.436), P^a < 0.001*

RCRI: Revised Cardiac Risk Index, includes renal insufficiency (creatinine≥2 mg/dL), insulin-dependent diabetes mellitus, heart failure, ischemic heart disease, cerebrovascular accident or TIA, intra-thoracic, intra-abdominal, or supra-inguinal vascular surgery; each one calculated as 1 score
CHA₂DS₂-VASc includes history of congestive heart failure (1 point), hypertension (1 point), age 65–74 (1 point) or ≥ 75 years (2 points), diabetes mellitus (1 point), stroke, transient ischemic attack or thromboembolism (2 points), vascular disease (1 point), and sex category (female)
a. Compared with RCRI grade alone; b. Hosmer-Lemeshow χ² statistic. PPV, positive predictive value; NPV, negative predictive value; NRI, net reclassification improvement; CI, confidence interval. * p < 0.05

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