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The goal of this observational study is to develop and evaluate an artificial intelligence (AI)-based multimodal model for predicting major cardiovascular events within 30 days after gastrointestinal surgery in adults at Bach Mai Hospital. The study will also compare the predictive performance of this AI-based model with commonly used traditional risk scores.
The main questions it aims to answer are:
Can an AI-based multimodal model predict major cardiovascular events within 30 days after gastrointestinal surgery? Does the AI-based model show better predictive performance than the Revised Cardiac Risk Index (RCRI), the American College of Surgeons National Surgical Quality Improvement Program Myocardial Infarction or Cardiac Arrest calculator (ACS NSQIP MICA), and the ACS NSQIP Surgical Risk Calculator (ACS NSQIP SRC)? Researchers will compare the AI-based multimodal model with traditional risk scores using measures of predictive performance, including discrimination, calibration, net reclassification improvement, and integrated discrimination improvement.
Participants will be adults undergoing gastrointestinal surgery. Researchers will review medical record data from patients treated in 2025 and will also collect the same types of clinical data prospectively in 2026. The clinical outcome being predicted is the occurrence of major cardiovascular events within 30 days after surgery. The study will not change routine clinical care.
Major cardiovascular events after gastrointestinal surgery remain an important cause of early postoperative complications and poor outcomes. Traditional perioperative cardiac risk scores, including the Revised Cardiac Risk Index (RCRI), the American College of Surgeons National Surgical Quality Improvement Program Myocardial Infarction or Cardiac Arrest calculator (ACS NSQIP MICA), and the ACS NSQIP Surgical Risk Calculator (ACS NSQIP SRC), are widely used in clinical practice. However, their performance may be limited in specific surgical populations and may not fully capture complex interactions among clinical, laboratory, physiologic, and procedural variables.
This observational study aims to develop and evaluate an artificial intelligence (AI)-based multimodal model for predicting major cardiovascular events within 30 days after gastrointestinal surgery and to compare its predictive performance with traditional risk scores. The study will be conducted at Bach Mai Hospital and will include adult patients undergoing gastrointestinal surgery. The study uses a mixed retrospective-prospective design, with retrospective data collection from patients treated in 2025 and prospective data collection in 2026.
The target clinical outcome for prediction is the occurrence of major cardiovascular events within 30 days after surgery. These events include cardiovascular death, nonfatal myocardial infarction, cardiac arrest with return of spontaneous circulation, new stroke, and clinically significant arrhythmias requiring treatment. Data used for model development and comparison may include demographic characteristics, medical history, cardiovascular comorbidities, surgical characteristics, anesthetic information, preoperative laboratory results, electrocardiographic findings, biomarkers when available, and functional or risk assessment variables.
The primary outcome of the study is the discrimination performance of the AI-based multimodal model compared with traditional risk scores, measured by the area under the receiver operating characteristic curve for predicting 30-day major cardiovascular events after gastrointestinal surgery. Secondary outcomes include calibration performance, net reclassification improvement, and integrated discrimination improvement of the AI-based multimodal model compared with traditional risk scores, including RCRI, ACS NSQIP MICA, and ACS NSQIP SRC.
The study is observational and will not alter routine perioperative management. Data will be obtained from existing medical records and prospective clinical collection, coded for confidentiality, and analyzed to support risk stratification and model comparison in patients undergoing gastrointestinal surgery.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Overall Study Cohort | Adults undergoing gastrointestinal surgery at Bach Mai Hospital who are included in this observational study and followed for major cardiovascular events within 30 days after surgery. The study includes retrospective data from 2025 and prospective data from 2026. |
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| Measure | Description | Time Frame |
|---|---|---|
| Area under the receiver operating characteristic curve of the AI-based multimodal model for predicting 30-day major adverse cardiovascular events after gastrointestinal surgery | Discrimination performance of the AI-based multimodal model for predicting 30-day major adverse cardiovascular events after gastrointestinal surgery. | From the preoperative period to 30 days after surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Brier score of the AI-based multimodal model for predicting 30-day major cardiovascular events after gastrointestinal surgery | Overall prediction accuracy of the AI-based multimodal model as assessed by the Brier score. Lower values indicate better model performance. | From the preoperative period to 30 days after surgery |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients undergoing gastrointestinal surgery at Bach Mai Hospital from January 2025 through December 2026. The study includes patients identified retrospectively from 2025 and prospectively from 2026 who have sufficient perioperative clinical data for analysis of 30-day major cardiovascular events after surgery.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bach Mai hospital | Recruiting | HÃ Ná»™i | Vietnam |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 38008807 | Result | Gautam N, Mueller J, Alqaisi O, Gandhi T, Malkawi A, Tarun T, Alturkmani HJ, Zulqarnain MA, Pontone G, Al'Aref SJ. Machine Learning in Cardiovascular Risk Prediction and Precision Preventive Approaches. Curr Atheroscler Rep. 2023 Dec;25(12):1069-1081. doi: 10.1007/s11883-023-01174-3. Epub 2023 Nov 27. | |
| 39846062 | Result |
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Individual participant data will not be shared because the study uses hospital-based clinical data containing potentially identifiable information, and no formal external data-sharing plan has been approved.
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| Net Reclassification Improvement of the AI-Based Multimodal Model Compared With Traditional Risk Scores for Predicting 30-Day Major Cardiovascular Events After Gastrointestinal Surgery |
Net reclassification improvement of the AI-based multimodal model compared with traditional risk scores for prediction of major cardiovascular events within 30 days after gastrointestinal surgery. |
| Using perioperative data collected from the preoperative period through 30 days after surgery |
| Integrated Discrimination Improvement of the AI-Based Multimodal Model Compared With Traditional Risk Scores for Predicting 30-Day Major Cardiovascular Events After Gastrointestinal Surgery | Integrated discrimination improvement of the AI-based multimodal model compared with traditional risk scores for prediction of major cardiovascular events within 30 days after gastrointestinal surgery. | Using perioperative data collected from the preoperative period through 30 days after surgery |
| Area under the receiver operating characteristic curve of the Revised Cardiac Risk Index for predicting 30-day major cardiovascular events after gastrointestinal surgery | Discrimination performance of the Revised Cardiac Risk Index. | From the preoperative period to 30 days after surgery |
| Area under the receiver operating characteristic curve of the ACS NSQIP Surgical Risk Calculator for predicting 30-day major cardiovascular events after gastrointestinal surgery | Discrimination performance of the ACS NSQIP Surgical Risk Calculator. | From the preoperative period to 30 days after surgery |
| Calibration slope of the AI-based multimodal model for predicting 30-day major cardiovascular events after gastrointestinal surgery | Agreement between predicted and observed risk as assessed by the calibration slope. A value closer to 1 indicates better calibration. | From the preoperative period to 30 days after surgery |
| Liu T, Krentz A, Lu L, Curcin V. Machine learning based prediction models for cardiovascular disease risk using electronic health records data: systematic review and meta-analysis. Eur Heart J Digit Health. 2024 Oct 27;6(1):7-22. doi: 10.1093/ehjdh/ztae080. eCollection 2025 Jan. |
| 39039467 | Result | Cheng CH, Lee BJ, Nfor ON, Hsiao CH, Huang YC, Liaw YP. Using machine learning-based algorithms to construct cardiovascular risk prediction models for Taiwanese adults based on traditional and novel risk factors. BMC Med Inform Decis Mak. 2024 Jul 22;24(1):199. doi: 10.1186/s12911-024-02603-2. |
| 38264696 | Result | Li C, Liu X, Shen P, Sun Y, Zhou T, Chen W, Chen Q, Lin H, Tang X, Gao P. Improving cardiovascular risk prediction through machine learning modelling of irregularly repeated electronic health records. Eur Heart J Digit Health. 2023 Oct 17;5(1):30-40. doi: 10.1093/ehjdh/ztad058. eCollection 2024 Jan. |
| 40480877 | Result | Kothari P, Vanneman MW, Choi C, Diehl R, Fielding-Singh V. Highlights from the American College of Cardiology and American Heart Association 2024 Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery. J Cardiothorac Vasc Anesth. 2025 Sep;39(9):2408-2420. doi: 10.1053/j.jvca.2025.05.014. Epub 2025 May 14. |
| 28444280 | Result | Writing Committee for the VISION Study Investigators; Devereaux PJ, Biccard BM, Sigamani A, Xavier D, Chan MTV, Srinathan SK, Walsh M, Abraham V, Pearse R, Wang CY, Sessler DI, Kurz A, Szczeklik W, Berwanger O, Villar JC, Malaga G, Garg AX, Chow CK, Ackland G, Patel A, Borges FK, Belley-Cote EP, Duceppe E, Spence J, Tandon V, Williams C, Sapsford RJ, Polanczyk CA, Tiboni M, Alonso-Coello P, Faruqui A, Heels-Ansdell D, Lamy A, Whitlock R, LeManach Y, Roshanov PS, McGillion M, Kavsak P, McQueen MJ, Thabane L, Rodseth RN, Buse GAL, Bhandari M, Garutti I, Jacka MJ, Schunemann HJ, Cortes OL, Coriat P, Dvirnik N, Botto F, Pettit S, Jaffe AS, Guyatt GH. Association of Postoperative High-Sensitivity Troponin Levels With Myocardial Injury and 30-Day Mortality Among Patients Undergoing Noncardiac Surgery. JAMA. 2017 Apr 25;317(16):1642-1651. doi: 10.1001/jama.2017.4360. |
| 22706835 | Result | Vascular Events In Noncardiac Surgery Patients Cohort Evaluation (VISION) Study Investigators; Devereaux PJ, Chan MT, Alonso-Coello P, Walsh M, Berwanger O, Villar JC, Wang CY, Garutti RI, Jacka MJ, Sigamani A, Srinathan S, Biccard BM, Chow CK, Abraham V, Tiboni M, Pettit S, Szczeklik W, Lurati Buse G, Botto F, Guyatt G, Heels-Ansdell D, Sessler DI, Thorlund K, Garg AX, Mrkobrada M, Thomas S, Rodseth RN, Pearse RM, Thabane L, McQueen MJ, VanHelder T, Bhandari M, Bosch J, Kurz A, Polanczyk C, Malaga G, Nagele P, Le Manach Y, Leuwer M, Yusuf S. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2012 Jun 6;307(21):2295-304. doi: 10.1001/jama.2012.5502. |
| 39320289 | Result | Writing Committee Members; Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, Williams KA Sr. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024 Nov 5;84(19):1869-1969. doi: 10.1016/j.jacc.2024.06.013. Epub 2024 Sep 24. |
| 24055383 | Result | Bilimoria KY, Liu Y, Paruch JL, Zhou L, Kmiecik TE, Ko CY, Cohen ME. Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons. J Am Coll Surg. 2013 Nov;217(5):833-42.e1-3. doi: 10.1016/j.jamcollsurg.2013.07.385. Epub 2013 Sep 18. |
| 21730309 | Result | Gupta PK, Gupta H, Sundaram A, Kaushik M, Fang X, Miller WJ, Esterbrooks DJ, Hunter CB, Pipinos II, Johanning JM, Lynch TG, Forse RA, Mohiuddin SM, Mooss AN. Development and validation of a risk calculator for prediction of cardiac risk after surgery. Circulation. 2011 Jul 26;124(4):381-7. doi: 10.1161/CIRCULATIONAHA.110.015701. Epub 2011 Jul 5. |
| 10477528 | Result | Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, Sugarbaker DJ, Donaldson MC, Poss R, Ho KK, Ludwig LE, Pedan A, Goldman L. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999 Sep 7;100(10):1043-9. doi: 10.1161/01.cir.100.10.1043. |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D002318 | Cardiovascular Diseases |
| ID | Term |
|---|---|
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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