Background
Methods
Ethical statement
Population and outcomes
Statistical analysis
Results
MACCE and mortality
Age | Number of total population | Numbers of AMI (% of total population) | Numbers of HF (% of total population) | Numbers of stroke (% of total population) | Numbers of death (% of total population) | Numbers of MACCE (% of total population) |
---|---|---|---|---|---|---|
65–74 years | 5315 | 4 (0.075%) | 7 (0.132%) | 7 (0.132%) | 9 (0.169%) | 25 (0.470%) |
75–84 years | 3449 | 5 (0.145%) | 28 (0.812%) | 2 (0.058%) | 3 (0.087%) | 35 (1.015%) |
≥ 85 years | 975 | 7 (0.718%) | 13 (1.333%) | 3 (0.307%) | 8 (0.821%) | 24 (2.462%) |
Characteristics | All (n = 342) | Control group (n = 258) | MACCE group (n = 84) |
P
|
---|---|---|---|---|
Age (mean (SD)) | 77.05 (7.53) | 76.54 (7.50) | 78.63 (7.46) | 0.027 |
Age 65–74 years (%) | 129 (37.7) | 104 (40.3) | 25 (29.8) | 0.109 |
Age 75–84 years (%) | 147 (43.0) | 112 (43.4) | 35 (41.7) | 0.878 |
Age ≥ 85 years (%) | 59 (17.3) | 35 (13.6) | 24 (28.6) | 0.003 |
Height (mean (SD)) | 162.85 (8.65) | 163.03 (8.60) | 162.31 (8.84) | 0.51 |
Weight (mean (SD)) | 63.59 (12.20) | 63.97 (11.99) | 62.40 (12.84) | 0.307 |
Chronic respiratory disease (%) | 33 (9.6) | 23 (8.9) | 10 (11.9) | 0.553 |
CAD (%) | 96 (28.1) | 63 (24.4) | 33 (39.3) | 0.013 |
Positive exercise test (%) | 12 (3.5) | 7 (2.7) | 5 (6.0) | 0.289 |
Ischemic chest pain (%) | 16 (4.7) | 3 (1.2) | 13 (15.5) | < 0.001 |
CHF (%) | 19 (5.6) | 4 (1.6) | 15 (17.9) | < 0.001 |
Symptoms of decompensated HF (%) | 15 (4.4) | 2 (0.8) | 13 (15.5) | < 0.001 |
Arrhythmia (%) | 48 (14.0) | 26 (10.1) | 22 (26.2) | < 0.001 |
AF (%) | 43 (12.6) | 22 (8.5) | 21 (25.0) | < 0.001 |
Nitrate therapy (%) | 33 (9.6) | 17 (6.6) | 16 (19.0) | 0.002 |
VHD (%) | 25 (7.3) | 8 (3.1) | 17 (20.2) | < 0.001 |
Cr > 2.0 mg/dL (mean (SD)) | 0.04 (0.20) | 0.02 (0.15) | 0.10 (0.30) | 0.004 |
Blood transfusion (%) | 166 (48.5) | 115 (44.6) | 51 (60.7) | 0.014 |
The amount of transfused blood (mean (SD) | 673.13 (1650.54) | 428.52 (650.81) | 1424.40 (3020.58) | < 0.001 |
High-risk type of surgery (mean (SD)) | 0.37 (0.48) | 0.34 (0.47) | 0.45 (0.50) | 0.067 |
Intraperitoneal surgery (%) | 95 (27.8) | 66 (25.6) | 29 (34.5) | 0.147 |
General anesthesia (%) | 193 (56.4) | 138 (53.5) | 55 (65.5) | 0.072 |
NNIS class | ||||
0 (%) | 115 (33.6) | 92 (35.7) | 23 (27.4) | 0.207 |
1 (%) | 151 (44.2) | 108 (41.9) | 43 (51.2) | 0.171 |
2 (%) | 21 (6.1) | 10 (3.9) | 11 (13.1) | 0.005 |
3 (%) | 4 (1.2) | 2 (0.8) | 2 (2.4) | 0.545 |
Preoperative heart rate (mean (SD)) | 72.45 (47.88) | 69.08 (13.92) | 82.79 (93.14) | 0.022 |
Postoperative systolic blood pressure (mean (SD)) | 138.89 (22.38) | 141.15 (21.72) | 131.98 (23.07) | 0.001 |
Postoperative heart rate (mean (SD)) | 79.05 (16.05) | 77.69 (13.10) | 83.21 (22.43) | 0.006 |
Intraoperative minimum systolic blood pressure (mean (SD)) | 112.04 (21.28) | 113.45 (20.59) | 107.70 (22.85) | 0.031 |
Intraoperative minimum diastolic pressure (mean (SD)) | 54.25 (12.78) | 55.22 (11.91) | 51.25 (14.82) | 0.013 |
Minimum mean arterial pressure (mean (SD)) | 73.10 (14.41) | 74.25 (13.85) | 69.58 (15.58) | 0.01 |
Intraoperative maximum heart rate (mean (SD)) | 84.60 (18.97) | 82.44 (17.01) | 91.23 (22.89) | < 0.001 |
Sinus rhythm (%) | 312 (91.2) | 241 (93.4) | 71 (84.5) | 0.023 |
ECG with Q waves (%) | 43 (12.6) | 31 (12.0) | 12 (14.3) | 0.722 |
Myocardial ischemia changes in ECG (%) | 87 (25.4) | 58 (22.5) | 29 (34.5) | 0.04 |
L (mean (SD)) | 1.43 (0.68) | 1.48 (0.70) | 1.30 (0.61) | 0.046 |
ALT (mean (SD)) | 26.65 (42.76) | 23.23 (30.70) | 37.17 (66.66) | 0.009 |
ApoA-I (mean (SD)) | 274.33 (269.20) | 258.55 (260.51) | 322.81 (290.57) | 0.057 |
Left atrium diameter (mean (SD)) | 35.54 (5.17) | 35.05 (4.90) | 37.05 (5.67) | 0.002 |
Left ventricle transverse diameter (mean (SD)) | 35.65 (5.74) | 35.05 (5.24) | 37.48 (6.79) | 0.001 |
Left ventricular dilatation (mean (SD) | 0.12 (0.33) | 0.11 (0.31) | 0.17 (0.37) | 0.159 |
LVEF (mean (SD)) | 66.94 (7.05) | 67.82 (5.86) | 64.25 (9.40) | < 0.001 |
Left ventricle long diameter (mean (SD)) | 51.18 (7.41) | 50.33 (6.73) | 53.80 (8.75) | < 0.001 |
LVDd (mean (SD)) | 46.82 (4.49) | 46.64 (3.94) | 47.39 (5.85) | 0.18 |
Posterior wall thickness of left ventric (mean (SD)) | 9.79 (1.15) | 9.78 (1.14) | 9.81 (1.16) | 0.793 |
IVST (mean (SD)) | 10.37 (1.70) | 10.27 (1.19) | 10.68 (2.71) | 0.053 |
LVM I (mean (SD) | 105.70 (31.05) | 103.53 (27.29) | 112.34 (39.95) | 0.024 |
Left ventricular mass (LVM) (mean (SD) | 168.21 (43.65) | 165.41 (37.56) | 176.82 (57.96) | 0.037 |
MACCE | 0 | 84 (100%) | < 0.001 | |
AMI | 0 | 16 (19.05%) | ||
HF | 0 | 48 (57.14%) | ||
Stroke | 0 | 12 (14.29%) | ||
Death | 0 | 20 (23.81%) |
Risk factors
Characteristics | OR | CI.2.5. | CI.97.5. |
P
|
---|---|---|---|---|
Age | 1.038 | 0.998 | 1.081 | 0.0682 |
Age 65–74 years | 0.594 | 0.312 | 1.096 | 0.1026 |
Age 75–84 years | 0.984 | 0.544 | 1.766 | 0.9572 |
Age ≥ 85 years | 2.495 | 1.22 | 5.041 | 0.0111 |
Blood transfusion | 1.561 | 0.872 | 2.814 | 0.135 |
General anesthesia | 1.533 | 0.848 | 2.824 | 0.1627 |
NNIS Class | ||||
0 | 0.657 | 0.348 | 1.206 | 0.1829 |
1 | 1.678 | 0.936 | 3.025 | 0.0827 |
2 | 4.117 | 0.883 | 21.42 | 0.0692 |
3 | 6.034 | 0.568 | 131.225 | 0.1452 |
Sinus rhythm | 0.49 | 0.203 | 1.238 | 0.1179 |
Insulin | 0.591 | 0.166 | 1.652 | 0.3572 |
Stroke/TIA | 1.276 | 0.64 | 2.469 | 0.4766 |
Chronic respiratory disease | 1.321 | 0.486 | 3.273 | 0.562 |
CAD | 1.857 | 0.992 | 3.442 | 0.0502 |
Positive exercise test | 2.442 | 0.587 | 9.532 | 0.1943 |
Ischemic chest pain | 19.47 | 5.022 | 128.512 | 0.0002 |
CHF | 14.367 | 4.362 | 64.898 | 0.0001 |
Symptoms of decompensated HF | 26.868 | 4.777 | 504.118 | 0.0021 |
Arrhythmia | 3.254 | 1.552 | 6.804 | 0.0016 |
AF | 3.322 | 1.518 | 7.26 | 0.0024 |
Reduced LVEF | 15.893 | 2.495 | 307.917 | 0.0124 |
VHD | 6.824 | 2.316 | 22.752 | 0.0008 |
ECG with Q waves | 1.947 | 0.869 | 4.221 | 0.0958 |
Myocardial ischemia changes in ECG | 1.824 | 0.958 | 3.427 | 0.0633 |
Nitrate therapy | 4.139 | 1.688 | 10.369 | 0.0019 |
Intraperitoneal surgery | 1.66 | 0.876 | 3.102 | 0.1145 |
Cr > 2.0 mg/dL | 6.4 | 1.633 | 31.119 | 0.0103 |
The amount of transfused blood | 1 | 1 | 1.001 | 0.0139 |
Preoperative heart rate | 1.013 | 1 | 1.032 | 0.1921 |
Postoperative systolic blood pressure | 0.987 | 0.974 | 1 | 0.058 |
Postoperative pluse | 1.01 | 0.991 | 1.029 | 0.3109 |
Intraoperative minimum systolic blood pressure | 0.99 | 0.974 | 1.005 | 0.1801 |
Intraoperative minimum diastolic pressure | 0.976 | 0.951 | 0.999 | 0.052 |
Minimum mean arterial pressure | 0.98 | 0.958 | 1.001 | 0.0677 |
Intraoperative maximum heart rate | 1.018 | 1.003 | 1.034 | 0.0195 |
L | 0.693 | 0.43 | 1.074 | 0.1151 |
ALT | 1.004 | 0.998 | 1.011 | 0.2251 |
ApoA-I | 1.001 | 1 | 1.002 | 0.0304 |
Left atrium diameter | 1.069 | 1.011 | 1.132 | 0.0187 |
Left—ventricle transverse diameter | 1.064 | 1.013 | 1.118 | 0.013 |
Left ventricular dilatation | 1.457 | 0.596 | 3.342 | 0.3865 |
LVEF | 0.929 | 0.887 | 0.969 | 0.001 |
High-risk type of surgery | 1.891 | 1.044 | 3.424 | 0.035 |
Left—ventricle long diameter | 1.068 | 1.025 | 1.115 | 0.0021 |
LVDd | 1.029 | 0.965 | 1.098 | 0.381 |
Posterior wall thickness of left ventric | 0.995 | 0.776 | 1.276 | 0.971 |
IVST | 1.093 | 0.893 | 1.337 | 0.3718 |
Height | 1.005 | 0.972 | 1.04 | 0.7513 |
Weight | 0.991 | 0.967 | 1.015 | 0.4555 |
LVMI | 1.004 | 0.996 | 1.013 | 0.3111 |
Left ventricular mass | 1.004 | 0.997 | 1.01 | 0.2773 |
Contribution and performance of the new prediction nomogram
Logistic regression | Decision Tree | XGBoost | Support Vector Machine | K-nearest Neighbor | Neural Network | |
---|---|---|---|---|---|---|
AUC | 0.891 [0.818–0.963] | 0.824 [0.718–0.930] | 0.903 [0.839–0.968] | 0.901 [0.839–0.963] | 0.803 [0.712–0.894] | 0.789 [0.677–0.900] |
Sensitivity | 0.8261 | 0.7826 | 0.8261 | 0.9130 | 0.8261 | 0.6087 |
Specificity | 0.8228 | 0.8608 | 0.9114 | 0.7342 | 0.6329 | 0.8987 |
Accuracy | 0.824 [0.736–0.892] | 0.843 [0.758–0.908] | 0.892 [0.815–0.945] | 0.775 [0.681–0.851] | 0.677 [0.577–0.766] | 0.833 [0.747–0.900] |
Pos Pred Value | 0.5758 | 0.6207 | 0.7308 | 0.5000 | 0.3958 | 0.6364 |
Neg Pred Value | 0.9420 | 0.6207 | 0.9474 | 0.9667 | 0.9259 | 0.8875 |
F1 score | 0.6786 | 0.6923 | 0.7755 | 0.6462 | 0.5352 | 0.622 |