Article ; Online: Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study.
British journal of anaesthesia
2024 Volume 132, Issue 4, Page(s) 675–684
Abstract: Background: In 2022, the European Society of Cardiology updated guidelines for preoperative evaluation. The aims of this study were to quantify: (1) the impact of the updated recommendations on the yield of pathological findings compared with the ... ...
| Abstract | Background: In 2022, the European Society of Cardiology updated guidelines for preoperative evaluation. The aims of this study were to quantify: (1) the impact of the updated recommendations on the yield of pathological findings compared with the previous guidelines published in 2014; (2) the impact of preoperative B-type natriuretic peptide (NT-proBNP) use for risk estimation on the yield of pathological findings; and (3) the association between 2022 guideline adherence and outcomes. Methods: This was a secondary analysis of MET-REPAIR, an international, prospective observational cohort study (NCT03016936). Primary endpoints were reduced ejection fraction (EF<40%), stress-induced ischaemia, and major adverse cardiovascular events (MACE). The explanatory variables were class of recommendations for transthoracic echocardiography (TTE), stress imaging, and guideline adherence. We conducted second-order Monte Carlo simulations and multivariable regression. Results: In total, 15,529 patients (39% female, median age 72 [inter-quartile range: 67-78] yr) were included. The 2022 update changed the recommendation for preoperative TTE in 39.7% patients, and for preoperative stress imaging in 12.9% patients. The update resulted in missing 1 EF <40% every 3 fewer conducted TTE, and in 4 additional stress imaging per 1 additionally detected ischaemia events. For cardiac stress testing, four more investigations were performed for every 1 additionally detected ischaemia episodes. Use of NT-proBNP did not improve the yield of pathological findings. Multivariable regression analysis failed to find an association between adherence to the updated guidelines and MACE. Conclusions: The 2022 update for preoperative cardiac testing resulted in a relevant increase in tests receiving a stronger recommendation. The updated recommendations for TTE did not improve the yield of pathological cardiac testing. |
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| MeSH term(s) | Humans ; Female ; Aged ; Male ; Prospective Studies ; Cardiology ; Echocardiography ; Natriuretic Peptide, Brain ; Peptide Fragments ; Ischemia ; Biomarkers |
| Chemical Substances | Natriuretic Peptide, Brain (114471-18-0) ; Peptide Fragments ; Biomarkers |
| Language | English |
| Publishing date | 2024-02-09 |
| Publishing country | England |
| Document type | Observational Study ; Journal Article |
| ZDB-ID | 80074-0 |
| ISSN | 1471-6771 ; 0007-0912 |
| ISSN (online) | 1471-6771 |
| ISSN | 0007-0912 |
| DOI | 10.1016/j.bja.2023.12.036 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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