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September 4, 2026Journal of Clinical MedicineOpen Access

External Validation of Clinical Risk Scores and Machine Learning Models for Predicting 30-Day Cardiovascular Risk After Noncardiac Surgery: The PERICARE Study

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Why the study?

Do machine learning models improve the prediction of 30-day major adverse cardiac events in patients undergoing noncardiac surgery compared to established clinical risk scores?

Population

1,085 patients undergoing noncardiac surgery across a site-separated two-center cohort.

Comparison

Ten machine learning algorithms trained on… vs Established clinical risk scores.

Design

Cohort

Follow-up

30-day

Key result

Machine learning models demonstrated metric-dependent performance but no statistically significant discrimination advantage over the AUB-HAS2 clinical risk score for predicting 30-day MACE (all p>0.05).

Authors

AEAslan ErdoğanŞYŞeyma YeşilGAGamze Gençol Akçay

Discussion

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Member takes

Overview

ML models for preoperative MACE prediction need prospective validation across centers; leaves open superiority over clinical scores in routine practice.

Study Design

Type

Cohort (n=1,085)

Multicenter

Yes

Structured PICO

Do machine learning models improve the prediction of 30-day major adverse cardiac events in patients undergoing noncardiac surgery compared to established clinical risk scores?

P
Population
1,085 patients undergoing noncardiac surgery across two centers, evaluated for 30-day major adverse cardiac events.
E
Exposure
Ten machine learning algorithms trained on preoperative variables for predicting 30-day major adverse cardiac events.
C
Comparator
Established clinical risk scores (American University of Beirut-HAS2 [AUB-HAS2], American Society of Anesthesiologists [ASA], and Revised Cardiac Risk Index [RCRI]).
O
Outcome
30-day major adverse cardiac events (MACE).composite

Main Result

Effect estimate: AUROC 0.738 (95% CI 0.668-0.804)

p-value: p=>0.05

Machine learning models did not outperform the established AUB-HAS2 clinical risk score for predicting 30-day MACE after noncardiac surgery, highlighting the need for local recalibration and prospective evaluation before clinical deployment.

Limitations

  • Low event counts
  • Flexible-model results are hypothesis-generating
  • Local recalibration and prospective evaluation are prerequisites before clinical deployment
  • low event counts

Cite This Study

Erdoğan et al. (2026) conducted a cohort in Noncardiac surgery (n=1,085). Machine learning models vs. Established clinical risk scores (AUB-HAS2, ASA, RCRI) was evaluated on 30-day major adverse cardiac events (MACE) (AUROC 0.738, 95% CI 0.668-0.804, p=>0.05). Machine learning models demonstrated metric-dependent performance but no statistically significant discrimination advantage over the AUB-HAS2 clinical risk score for predicting 30-day MACE (all p>0.05).

synapsesocial.com/papers/6a9cd83783360d9cc055ff7bhttps://doi.org/10.3390/jcm15176848
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