Identificador persistente para citar o vincular este elemento: http://hdl.handle.net/10553/129067
Título: Hallazgos patológicos asociados con las directrices actualizadas de 2022 de la Sociedad Europea de Cardiología para pruebas cardíacas preoperatorias: un estudio observacional de modelado de cohortes
Otros títulos: Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study
Autores/as: Stroda, Alexandra
Mauermann, Eckhard
Ionescu, Daniela
Szczeklik, Wojciech
De Hert, Stefan
Filipovic, Miodrag
Beck Schimmer, Beatrice
Spadaro, Savino
Matute, Purificación
Ganter, Michael T.
Ovezov, Alexey
Turhan, Sanem C.
van Waes, Judith
Lagarto, Filipa
Theodoraki, Kassiani
Gupta, Anil
Gillmann, Hans Jörg
Guzzetti, Luca
Kotfis, Katarzyna
Larmann, Jan
Corneci, Dan
Buggy, Donal J.
Howell, Simon J.
Lurati Buse, Giovanna
Rodríguez Pérez, Aurelio Eduardo 
Becerra Bolaños, Ángel 
Clasificación UNESCO: 320501 Cardiología
Palabras clave: Echocardiography
Ejection fraction
Guideline adherence
Major adverse cardiovascular events
NT-proBNP, et al.
Fecha de publicación: 2024
Publicación seriada: British journal of anaesthesia 
Resumen: 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.
URI: http://hdl.handle.net/10553/129067
ISSN: 0007-0912
DOI: 10.1016/j.bja.2023.12.036
Fuente: British Journal of Anaesthesia December, [ISSN 007-0912], (2024).
Colección:Artículos
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