Τίτλος:
Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Guidelines endorse self-reported functional capacity for preoperative cardiovascular assessment, although evidence for its predictive value is inconsistent. We hypothesised that self-reported effort tolerance improves prediction of major adverse cardiovascular events (MACEs) after noncardiac surgery. Methods: This is an international prospective cohort study (June 2017 to April 2020) in patients undergoing elective noncardiac surgery at elevated cardiovascular risk. Exposures were (i) questionnaire-estimated effort tolerance in metabolic equivalents (METs), (ii) number of floors climbed without resting, (iii) self-perceived cardiopulmonary fitness compared with peers, and (iv) level of regularly performed physical activity. The primary endpoint was in-hospital MACE consisting of cardiovascular mortality, non-fatal cardiac arrest, acute myocardial infarction, stroke, and congestive heart failure requiring transfer to a higher unit of care or resulting in a prolongation of stay on ICU/intermediate care (≥24 h). Mixed-effects logistic regression models were calculated. Results: In this study, 274 (1.8%) of 15 406 patients experienced MACE. Loss of follow-up was 2%. All self-reported functional capacity measures were independently associated with MACE but did not improve discrimination (area under the curve of receiver operating characteristic [ROC AUC]) over an internal clinical risk model (ROC AUCbaseline 0.74 [0.71–0.77], ROC AUCbaseline+4METs 0.74 [0.71–0.77], ROC AUCbaseline+floors climbed 0.75 [0.71–0.78], AUCbaseline+fitness vs peers 0.74 [0.71–0.77], and AUCbaseline+physical activity 0.75 [0.72–0.78]). Conclusions: Assessment of self-reported functional capacity expressed in METs or using the other measures assessed here did not improve prognostic accuracy compared with clinical risk factors. Caution is needed in the use of self-reported functional capacity to guide clinical decisions resulting from risk assessment in patients undergoing noncardiac surgery. Clinical trial registration: NCT03016936. © 2023 British Journal of Anaesthesia
Συγγραφείς:
Lurati Buse, G.A.
Mauermann, E.
Ionescu, D.
Szczeklik, W.
De Hert, S.
Filipovic, M.
Beck-Schimmer, B.
Spadaro, S.
Matute, P.
Bolliger, D.
Turhan, S.C.
van Waes, J.
Lagarto, F.
Theodoraki, K.
Gupta, A.
Gillmann, H.-J.
Guzzetti, L.
Kotfis, K.
Wulf, H.
Larmann, J.
Corneci, D.
Chammartin-Basnet, F.
Howell, S.J.
the MET: Reevaluation for Perioperative Cardiac Risk investigators
Περιοδικό:
BRITISH JOURNAL OF ANAESTHESIA
Εκδότης:
Elsevier Ireland Ltd
Λέξεις-κλειδιά:
insulin; oral antidiabetic agent, adult; aged; Article; cardiorespiratory fitness; cardiovascular disease; cardiovascular risk; cohort analysis; diabetes mellitus; elective surgery; female; follow up; functional status; human; insulin treatment; major clinical study; male; metabolic equivalent; middle aged; physical activity; prospective study; risk assessment; self report; stair climbing; heart infarction; postoperative complication; risk assessment; risk factor; self report, Humans; Myocardial Infarction; Postoperative Complications; Prospective Studies; Risk Assessment; Risk Factors; Self Report
DOI:
10.1016/j.bja.2023.02.030
