MP42-07 MAJOR ADVERSE CARDIOVASCULAR EVENTS FOLLOWING PARTIAL NEPHRECTOMY: A NOVEL RISK INDEX

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III (MP42)1 Sep 2021MP42-07 MAJOR ADVERSE CARDIOVASCULAR EVENTS FOLLOWING PARTIAL NEPHRECTOMY: A NOVEL RISK INDEX Ali Nasrallah, Habib Dakik, Nassib Abou Heidar, Jad Najdi, Oussama Nasrallah, Mazen Mansour, and Albert El Hajj Ali NasrallahAli Nasrallah More articles by this author , Habib DakikHabib Dakik More articles by this author , Nassib Abou HeidarNassib Abou Heidar More articles by this author , Jad NajdiJad Najdi More articles by this author , Oussama NasrallahOussama Nasrallah More articles by this author , Mazen MansourMazen Mansour More articles by this author , and Albert El HajjAlbert El Hajj More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002063.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Partial Nephrectomy (PN) is a procedure which aims to preserve renal functionality and minimize morbidity in patients with localized kidney tumors. However, it is associated with a non-negligible risk of cardiovascular morbidity and mortality in a subgroup of high-risk patients. We aim to develop a procedure-specific risk-index, assess its performance, and compare it to widely-used universal risk indices. METHODS: Using the American College of Surgeons – National Surgical Quality Improvement Program (ACS-NSQIP) database. The primary outcome MACE was defined as incidence of myocardial infarction, stroke, or any 30-day mortality. A multivariable logistic regression model was constructed, and model performance and calibration were evaluated using a ROC analysis and the Hosmer-Lemeshow test respectively. The performance of the Revised Cardiac Risk Index (RCRI) and the AUB-HAS2 Cardiovascular Risk Index in the PN cohort was compared to the novel index. RESULTS: A total of 4,795 patients were included in the study. In total, 52 (1.1%) patients had incidence of MACE. A univariate analysis yielded thirteen eligible variables for entry into the multivariate analysis. The final PN-A4CH model (Table 1) comprised six variables: Age ≥75 years, ASA Class >2, Anemia, surgical Approach, Creatinine >1.5 mg/dL, and history of Heart disease. Index performance was assessed, and ROC analysis provided a C-statistic of 0.81, calibration R2 was 0.99, and sensitivity was 85%. The index was compared to the RCRI and AUB-HAS2 indices, which attained ROC C-Statistics of 0.59 and 0.68 respectively (Figure 1). CONCLUSIONS: The authors propose a novel procedure-specific cardiovascular risk-prediction index for partial nephrectomy. The PN-A4CH index displayed sufficient predictive ability, excellent calibration, and outperformed universal risk indices. The index may aid in better patient selection and optimization of management in high-risk individuals. Source of Funding: None to declare © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e773-e774 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Nasrallah More articles by this author Habib Dakik More articles by this author Nassib Abou Heidar More articles by this author Jad Najdi More articles by this author Oussama Nasrallah More articles by this author Mazen Mansour More articles by this author Albert El Hajj More articles by this author Expand All Advertisement Loading ...