Identificador persistente para citar o vincular este elemento: http://hdl.handle.net/10553/123895
Título: Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study
Autores/as: Giovanna A, Lurati Buse
Mauermann, Eckhard
Ionescu, Daniela
Szczeklik, Wojciech
De Hert, Stefan
Filipovic, Miodrag
Beck-Schimmer, Beatrice
Spadaro, Savino
Matute, Purificación
Bolliger, Daniel
Turhan Cakar, Sanem
van Waes, Judith
Lagarto, Filipa
Theodoraki, Kassiani
Gupta, Anil
Gillmann, Hans-Jörg
Guzzetti, Luca
Kotfis, Katarzyna
Wulf, Hinnerk
Larmann, Jan
Corneci, Dan
Chammartin-Basnet, Frederique
Howell, Simon J.
Rodríguez Pérez, Aurelio Eduardo 
Becerra-Bolaños, Ángel
Clasificación UNESCO: 320501 Cardiología
321307 Cirugía del corazón
Palabras clave: Cohort study
Effort tolerance
Functional capacity
Major adverse cardiovascular events
Noncardiac surgery, et al.
Fecha de publicación: 2023
Proyectos: MET-REPAIR
Publicación seriada: British journal of anaesthesia 
Resumen: 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.
URI: http://hdl.handle.net/10553/123895
ISSN: 0007-0912
DOI: 10.1016/j.bja.2023.02.030
Fuente: British Journal of Anaesthesia, [ISSN 0007-0912], v. 130, (6), p. 655-665, ( Junio 2023)
Colección:Artículos
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