Background. Elderly patients undergoing hip or knee arthroplasty are at a risk for myocardial injury after noncardiac surgery (MINS). We evaluated the ability of five common cardiac risk scores, alone or combined with baseline high-sensitivity cardiac troponin I (hs-cTnI), in predicting MINS and postoperative day 2 (POD2) hs-cTnI levels in patients undergoing elective total hip or knee arthroplasty. Methods. This study is ancillary to the Genetics-InFormatics Trial (GIFT) of Warfarin Therapy to Prevent Deep Venous Thrombosis, which enrolled patients 65 years and older undergoing elective total hip or knee arthroplasty. The five cardiac risk scores evaluated were the atherosclerotic cardiovascular disease calculator (ASCVD), the Framingham risk score (FRS), the American College of Surgeon’s National Surgical Quality Improvement Program (ACS-NSQIP) calculator, the revised cardiac risk index (RCRI), and the reconstructed RCRI (R-RCRI). Results. None of the scores predicted MINS in women. Among men, the ASCVD (C-statistic of 0.66; ), ACS-NSQIP (C-statistic of 0.69; ), and RCRI (C-statistic of 0.64; ) predicted MINS. Among all patients, spearman correlations (r_s) of the risk scores with the POD2 hs-cTnI levels were 0.24, 0.20, 0.11, 0.11, and 0.08 for the ASCVD, Framingham, ACS-NSQIP, RCRI, and R-RCRI scores, respectively, with values of <0.001, <0.001, <0.001, 0.006, and 0.025. Baseline hs-cTnI predicted MINS (C-statistics: 0.63 in women and 0.72 in men) and postoperative hs-cTnI (r_s = 0.51, ). Conclusion. In elderly patients undergoing elective hip or knee arthroplasty, several of the scores modestly predicted MINS in men and correlated with POD2 hs-cTnI.

中文翻译：

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预测接受择期髋关节或膝关节置换术患者的术后肌钙蛋白：五种心脏风险预测工具的比较

背景。接受髋关节或膝关节置换术的老年患者在非心脏手术 (MINS) 后存在心肌损伤的风险。我们评估了五种常见心脏风险评分，单独或与基线高敏心肌肌钙蛋白 I (hs-cTnI) 相结合，在预测择期全髋或膝关节患者的 MINS 和术后第 2 天 (POD2) hs-cTnI 水平方面的能力关节成形术。方法. 这项研究是华法林预防深静脉血栓形成的遗传学信息学试验 (GIFT) 的辅助研究，该试验招募了 65 岁及以上接受选择性全髋关节或膝关节置换术的患者。评估的五个心脏风险评分是动脉粥样硬化性心血管疾病计算器（ASCVD）、弗雷明汉风险评分（FRS）、美国外科学院的国家手术质量改进计划（ACS-NSQIP）计算器、修订后的心脏风险指数（RCRI）、和重建的 RCRI (R-RCRI)。结果。没有一个分数可以预测女性的 MINS。在男性中，ASCVD（C-统计量为 0.66；), ACS-NSQIP ( C - 统计量 0.69;)和 RCRI ( C统计量为 0.64;)预测的 MINS。在所有患者中，ASCVD、Framingham、ACS-NSQIP、RCRI 和 R-RCRI 评分的风险评分与 POD2 hs-cTnI 水平的 spearman 相关性 (rs) 分别为 0.24、0.20、0.11、0.11 和_0.08 ，分别为 <0.001、<0.001、<0.001、0.006 和 0.025。基线 hs-cTnI 预测 MINS（ C统计量：女性 0.63，男性 0.72）和术后 hs-cTnI（ r _s  = 0.51，）。 结论。在接受选择性髋关节或膝关节置换术的老年患者中，一些分数适度预测男性的 MINS，并与 POD2 hs-cTnI 相关。