title: Predicting the occurrence of major adverse cardiac events within 30 days of a vascular surgery: an empirical comparison of the minimum p value method and ROC curve approach using individual patient data meta-analysis.
abstract: We aimed to compare the minimum p value method and the area under the receiver operating characteristics (ROC) curve approach to categorize continuous biomarkers for the prediction of postoperative 30-day major adverse cardiac events in noncardiac vascular surgery patients. Individual-patient data from six cohorts reporting B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NTproBNP) were obtained. These biomarkers were dichotomized using the minimum p value method and compared with previously reported ROC curve-derived thresholds using logistic regression analysis. A final prediction model was developed, internally validated, and assessed for its sensitivity to clustering effects. Finally, a preoperative risk score system was proposed. Thresholds identified by the minimum p value method and ROC curve approach were 115.57 pg/ml (p < 0.001) and 116 pg/ml for BNP, and 241.7 pg/ml (p = 0.001) and 277.5 pg/ml for NTproBNP, respectively. The minimum p value thresholds were slightly stronger predictors based on our logistic regression analysis. The final model included a composite predictor of the minimum p value method's BNP and NTproBNP thresholds [odds ratio (OR) = 8.5, p < 0.001], surgery type (OR = 2.5, p = 0.002), and diabetes (OR = 2.1, p = 0.015). Preoperative risks using the scoring system ranged from 2 to 49 %. The minimum p value method and ROC curve approach identify similar optimal thresholds. We propose to replace the revised cardiac risk index with our risk score system for individual-specific preoperative risk stratification after noncardiac nonvascular surgery.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Sciences Centre, Room 2C7, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada.
authors.forename: Thuva
authors.initials: T
authors.lastname: Vanniyasingam
authors.affiliation: Perioperative Research Unit, Department of Anaesthetics, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, South Africa ; Department of Anaesthetics, Grey's Hospital, Pietermaritzburg, South Africa.
authors.forename: Reitze N
authors.initials: RN
authors.lastname: Rodseth
authors.affiliation: Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
authors.forename: Giovanna A
authors.initials: GA
authors.lastname: Lurati Buse
authors.affiliation: Department of Anaesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Bolliger
authors.affiliation: Department of Anaesthesiology, Kantonsspital Graubunden, Chur, Switzerland.
authors.forename: Christoph S
authors.initials: CS
authors.lastname: Burkhart
authors.affiliation: Department of Critical Care Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, ON Canada.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Cuthbertson
authors.affiliation: Queen Elizabeth University Hospital, Glasgow, UK.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Gibson
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mahla
authors.affiliation: Division of Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: David W
authors.initials: DW
authors.lastname: Leibowitz
authors.affiliation: Department of Anaesthesia and Perioperative Medicine, University of Cape Town, Cape Town, South Africa.
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Biccard
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Health Sciences Centre, Room 2C7, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada ; Population Health Research Institute, Hamilton Health Sciences, Hamilton, ON Canada ; Biostatistics Unit, St Joseph's Healthcare, Hamilton, ON Canada ; Departments of Paediatrics and Anaesthesia, McMaster University, Hamilton, ON Canada ; Centre for Evaluation of Medicine, St Joseph's Healthcare, Hamilton, ON Canada.
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
keywords: Biostatistics; Cardiovascular epidemiology; Minimum p value; Pre-operative risk; ROC curve approach; Vascular surgery