Predictive Value of a Novel Frailty Index for Cardiovascular Outcomes after Major Noncardiac Surgery: A Prospective Cohort Study

作者：Yi-Shan Xie, Shao-Hui Lei, Shikun Wen, Jiaqi Wang, Ya Zhang, Jiaming Liu, Wen-Chi Luo, Zhen-Lue Li, Huan-Chuan Peng, Ke‐Xuan Liu, Bing-Cheng Zhao, for the PREVENGE-CB Collaborators · 发表于：Anesthesiology · 年份：2025 · DOI：10.1097/aln.0000000000005426 · 被引用次数：4 · 研究领域：Frailty in Older Adults、Cardiac, Anesthesia and Surgical Outcomes、Intensive Care Unit Cognitive Disorders

BACKGROUND: Older patients undergoing noncardiac surgery are at risk of postoperative cardiovascular events. Accurate cardiovascular risk assessment is important for informed decision-making. METHODS: This prospective cohort study enrolled older patients undergoing elective major noncardiac surgery. A frailty index based on preoperative geriatric assessment (FI-PGA) was constructed using 32 health-related parameters. The primary outcome was the occurrence of any cardiovascular events within 30 days after surgery. The associations between the FI-PGA and outcomes were assessed using logistic regression models. The added predictive value was evaluated by comparing nested models using improvement in model fit, fraction of new predictive information, net reclassification improvement, and decision curve analysis. The predictive performance of the Clinical Frailty Scale was also evaluated. RESULTS: A total of 1,808 patients were included, with 316 (17.5%) patients experiencing the primary outcome. The FI-PGA was associated with increased odds of the primary outcome after adjustment for clinical predictors (odds ratio, 1.56; 95% CI, 1.33 to 1.82 per 0.1-point increment), and clinical predictors plus preoperative N-terminal pro-B-type natriuretic peptide (odds ratio, 1.37; 95% CI, 1.16 to 1.61 per 0.1-point increment). Integration of the FI-PGA in prediction models significantly improved model fit and provided new predictive information. Net reclassification improvement analysis showe...