The added value of different biomarkers to the Revised Cardiac Risk Index to predict major adverse cardiac events and all‐cause mortality after noncardiac surgery

摘要

This is a protocol for a Cochrane Review (Prognosis). The objectives are as follows:The primary objective of this Cochrane Review is to quantify the added predictive value of several biomarkers to the Revised Cardiac Risk Index (RCRI) and to estimate the predictive performance of biomarkers compared to the RCRI alone to predict major adverse cardiac events (MACEs) and all‐cause mortality in patients undergoing noncardiac surgery. Table 1 represents the PICOTS of the review based on the CHARMS checklist ().Table 1. PICOTS of the review based on the CHARMS checklist frame="hsides" rules="groups" border="1" class="rendered small default_table">> valign="top" rowspan="1" colspan="1">>Population targeted valign="top" rowspan="1" colspan="1">Patients undergoing noncardiac surgery> valign="top" rowspan="1" colspan="1">>Intervention (index model) valign="top" rowspan="1" colspan="1">Prognostic model; Revised Cardiac Risk Index (RCRI)> valign="top" rowspan="1" colspan="1">>Comparator model valign="top" rowspan="1" colspan="1">Addition of biomarkers to the RCRI or comparison of biomarkers alone to the RCRI> valign="top" rowspan="1" colspan="1">>Outcome(s) to be predicted valign="top" rowspan="1" colspan="1">Major adverse cardiac events (MACEs) and all‐cause mortality> valign="top" rowspan="1" colspan="1">>Time span of the prediction valign="top" rowspan="1" colspan="1">All time spans> valign="top" rowspan="1" colspan="1">>Setting (intended role and use of the model) valign="top" rowspan="1" colspan="1">To inform physicians preoperatively of the patient's risk of developing events after noncardiac surgeryInvestigation of sources of heterogeneity between studiesWe will assess sources of heterogeneity based on the population, outcome definitions and prediction horizons. The RCRI was originally developed for a noncardiac, nonvascular surgical population to predict in‐hospital MACEs. However, the RCRI has also been externally validated in vascular surgical patients (; ), in which the predictive performance was found to be moderate (). In addition, prediction horizons vary between studies from in‐hospital to long‐term events (e.g. postoperative 1‐year all‐cause mortality). Finally, the composition of items that defines MACEs varies among different studies.