Background:While postoperative myocardial injury remains a major driver of morbidity and mortality, the ability to accurately identify patients at risk remains limited despite decades of clinical research. The role of genetic information in predicting myocardial injury after noncardiac surgery (MINS) remains unknown and requires large scale electronic health record and genomic data sets.Methods:In this retrospective observational study of adult patients undergoing noncardiac surgery, we defined MINS as new troponin elevation within 30 days following surgery. To determine the incremental value of polygenic risk score (PRS) for coronary artery disease, we added the score to 3 models of MINS risk: revised cardiac risk index, a model comprised entirely of preoperative variables, and a model with combined preoperative plus intraoperative variables. We assessed performance without and with PRSs via area under the receiver operating characteristic curve and net reclassification index.Results:Among 90 053 procedures across 40 498 genotyped individuals, we observed 429 cases with MINS (0.5%). PRS for coronary artery disease was independently associated with MINS for each multivariable model created (odds ratio=1.12 [95% CI, 1.02–1.24], P=0.023 in the revised cardiac risk index-based model; odds ratio, 1.19 [95% CI, 1.07–1.31], P=0.001 in the preoperative model; and odds ratio, 1.17 [95% CI, 1.06–1.30], P=0.003 in the preoperative plus intraoperative model). The addition of clinical risk factors improved model discrimination. When PRS was included with preoperative and preoperative plus intraoperative models, up to 3.6% of procedures were shifted into a new outcome classification.Conclusions:The addition of a PRS does not significantly improve discrimination but remains independently associated with MINS and improves goodness of fit. As genetic analysis becomes more common, clinicians will have an opportunity to use polygenic risk to predict perioperative complications. Further studies are necessary to determine if PRSs can inform MINS surveillance.

中文翻译：

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使用多基因风险评分提高了对非心脏手术后心肌损伤的预测。

背景：虽然术后心肌损伤仍然是发病率和死亡率的主要驱动因素，但尽管进行了数十年的临床研究，但准确识别高危患者的能力仍然有限。遗传信息在预测非心脏手术（MINS）后心肌损伤中的作用仍然未知，需要大规模的电子健康记录和基因组数据集。方法：在这项对接受非心脏手术的成年患者的回顾性观察研究中，我们将 MINS 定义为新的肌钙蛋白升高手术后30天内。为了确定冠状动脉疾病的多基因风险评分 (PRS) 的增量值，我们将评分添加到 3 个 MINS 风险模型中：修订的心脏风险指数、完全由术前变量组成的模型以及术前和术中变量相结合的模型. 我们通过接受者操作特征曲线下的面积和净重分类指数评估了没有和有 PRS 的表现。结果：在 40 498 个基因分型个体的 90 053 个程序中，我们观察到 429 例 MINS (0.5%)。对于创建的每个多变量模型，冠状动脉疾病的 PRS 与 MINS 独立相关（优势比 = 1.12 [95% CI，1.02–1.24]，P = 0.023 在修正的基于心脏风险指数的模型中；优势比，1.19 [95% CI，1.07–1.31]，术前模型P = 0.001；和优势比，1.17 [95% CI，1.06–1.30]，P=0.003 在术前加术中模型中）。临床风险因素的加入提高了模型辨别能力。当术前和术前加术中模型中包含 PRS 时，高达 3.6% 的程序被转换为新的结果分类。结论：添加 PRS 不会显着提高辨别力，但仍与 MINS 独立相关，并提高了拟合优度。随着基因分析变得越来越普遍，临床医生将有机会使用多基因风险来预测围手术期并发症。需要进一步研究以确定 PRS 是否可以通知 MINS 监测。