TY - JOUR
T1 - Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity
T2 - international prospective cohort study
AU - MET: Reevaluation for Perioperative Cardiac Risk investigators
AU - Lurati Buse, Giovanna A
AU - Mauermann, Eckhard
AU - Ionescu, Daniela
AU - Szczeklik, Wojciech
AU - De Hert, Stefan
AU - Filipovic, Miodrag
AU - Beck-Schimmer, Beatrice
AU - Spadaro, Savino
AU - Matute, Purificación
AU - Bolliger, Daniel
AU - Turhan, Sanem Cakar
AU - van Waes, Judith
AU - Lagarto, Filipa
AU - Theodoraki, Kassiani
AU - Gupta, Anil
AU - Gillmann, Hans-Jörg
AU - Guzzetti, Luca
AU - Kotfis, Katarzyna
AU - Wulf, Hinnerk
AU - Larmann, Jan
AU - Corneci, Dan
AU - Chammartin-Basnet, Frederique
AU - Howell, Simon J
AU - Hollmann, M.W.
N1 - Copyright © 2023 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.
PY - 2023/6
Y1 - 2023/6
N2 - 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+fitnessvspeers 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.
AB - 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+fitnessvspeers 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.
KW - Humans
KW - Myocardial Infarction/etiology
KW - Postoperative Complications/etiology
KW - Prospective Studies
KW - Risk Assessment
KW - Risk Factors
KW - Self Report
U2 - https://doi.org/10.1016/j.bja.2023.02.030
DO - https://doi.org/10.1016/j.bja.2023.02.030
M3 - Article
C2 - 37012173
SN - 0007-0912
VL - 130
SP - 655
EP - 665
JO - British Journal of Anaesthesia
JF - British Journal of Anaesthesia
IS - 6
ER -