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Risk assessment for major adverse cardiovascular events after noncardiac surgery using self-reported functional capacity: international prospective cohort study

2023; Elsevier BV; Volume: 130; Issue: 6 Linguagem: Inglês

10.1016/j.bja.2023.02.030

1471-6771

Giovanna Lurati Buse, Eckhard Mauermann, Daniela Ionescu, Wojciech Szczeklik, Stefan De Hert, Miodrag Filipovic, Beatrice Beck‐Schimmer, Savino Spadaro, P. Matute, Daniel Bolliger, Sanem Çakar Turhan, Judith van Waes, Filipa Lagarto, Kassiani Theodoraki, Anil Gupta, Hans-Jörg Gillmann, Luca Guzzetti, Katarzyna Kotfis, Hinnerk Wulf, Jan Larmann, Dan Corneci, Frédérique Chammartin, Simon Howell, Giovanna Lurati, Savino Spadaro, P. Matute, Daniela Ionescu, Daniel Bolliger, Wojciech Szczeklik, Sanem Çakar Turhan, Judith van Waes, Filipa Lagarto, Kassiani Theodoraki, Simon Howell, Anil Gupta, Stefan De Hert, А. М. Овезов, Luis Tollinche, Билјана Кузмановска, Stjepan Barišin, Peter Poredoš, Daniela Arabadzhieva, Dragana Unić-Stojanović, Edith Fleischmann, Claude Meistelman, Donal J. Buggy, Paul Calleja, Antigona Hasani, Johann Kemper, Lena Kohaupt, Jette Witzler, Michael Tuzhikov, Sebastian Roth, Alexandra Stroda, Cornelia Schultze, Nele Verbarg, Christian Gehrke, A Klemann, Friederike Hagebölling, Svenja Albrecht, Jakob Stroeder, Ann‐Kristin Schubert, Florian Espeter, Benedikt Russe, Markus Weigand, Lars Bergmann, Matthias Unterberg, Petra Bischoff, Raphael Pirzer, Patric Rene Rach, Klaus Ott, Alexander Zarbock, Ana Kowark, Claudia Neumann, Bahareh Marchand, Christoph Sponholz, Henrik Rueffert, Mira Krämer, Florian Piekarski, Melissa Carollo, Cecilia Novazzi, Fiorenza Toso, Alessandro Bacuzzi, Riccardo Ragazzi, Carlo Alberto Volta, Francesco De Giorgi, Barbara Bacer, Antonio Federico, Davide Chiumello, Luigi Vetrugno, Alberto Castella, Simonetta Tesoro, Antonella Cotoia, Elena Bignami, Agrippino Bellissima, Andrea Cortegiani, Marco Crisman, Arturo Toninelli, Ornella Piazza, Lucia Mirabella, Matteo Bossolasco, Francesco Bona, Juan Perdomo, Miquel Coca‐Martinez, Albert Carramiñana, Marta Giné Servén, Astrid Batalla González, José Maria Gil Sánchez, Ángel Ignacio Lledó Becerra, Aurelio Rodríguez, Anna Artigas Soler, Morena Anna Basso, Anna Peig Font, Diana Vernetta, Julia Hernando Santos, Enrique Alday Muñoz, Mercedes Cabellos Olivares, G. Marco, María Bermúdez López, Javier Barrio, María Isabel Forés, Estefanía Boix, Mercedes Ayuso, Bogdan Petre, Ioana Oprea, Mihai Dan Latiș, Simona Mărgărit, Horatiu Vasian, Dana Tomescu, I. Cîndea, Dan Sebastian Dîrzu, Sanda-Maria Copotoiu, Alida Moise, Șerban Bubenek-Turconi, Liana Văleanu, Patrick M. Wanner, Mirjana Djurdjevic, Sandra Nuth, Esther Seeberger, Nicolai Goettel, Firmin Kamber, Michael T. Ganter, Thomas Jan Gerber, Daniela Schneebeli, Andreas Pregernig, Sina Grape, Simon Tomala, Bernardo Bollen Pinto, Maciej Żukowski, Małgorzata Zegan-Barańska, Igor Karolak, Łukasz J. Krzych, Szymon Czajka, Dorota Studzińska, Anna Kluzik, Tomasz Koszel, Izabela Pabjańczyk, Anna Gajdosz, Süheyla Karadağ Erkoç, Başak Ceyda Meço, Ahmet Kemalettin Koltka, Muserref Beril Dincer, Perihan Elif Ekmekçi, Kemal Tolga Saraçoğlu, Filiz Alkaya Solmaz, Menekşe Özçelik, Oğuzhan Arun, Özlem Korkmaz Dilmen, Benedikt Preckel, Markus W. Hollmann, Yannick Hazen, Hans D. de Boer, Anne H. Epema, Seppe Koopman, Felix van Lier, Rita Del Pinto, André Carrão, Daniel Araki Ribeiro, Joana Mourão, Miguel Coelho, Nuno Losa, Nuno Santos, Luı́s Cabral, Diana Afonso, Sérgio Zenha, Cristina Ramos, Carla Hipólito, Maria Vasilaki, Antonia Andreeva, Donika Zaimi, Athanasios Chalkias, Maria Spyraki, Martina Rekatsina, Georgia Tsaousi, Anthony Short, Sonja Meier, Thumuluru Kavitha Madhuri, Scott Latham, James Knock, Andrew Drummond, Fiona Ramsden, Agnieszka Kubisz-Pudelko, James R. Walker, Iain Moppett, Louise J. White, Matthew Jackson, Henrik Reschreiter, Richard Innes, Michelle S. Chew, Sigridur Kalman, Jakob Walldén, Anna Schening, Lina Jonikaite, Anna Enlund, Luc De Baerdemaeker, Stuart Morrison, Steffen Rex, Alexandros Alexis, Viktoria E. Khoronenko, А. М. Овезов, В. А. Бельский, Kseniya Kaznacheeva, А. И. Грицан, Luis Tollinche, Cindy Yeoh, Билјана Кузмановска, Liljana Malinovska-Nikolovska, Stjepan Barišin, Peter Poredoš, Daniela Arabadzhieva, Dragana Unić-Stojanović, Mlađjan Golubović, Edith Fleischmann, Oskar Kotzinger, Marc Danguy des Déserts, Nicolas Ducrocq, Donal J. Buggy, Jean François Bonnet, Barbara Cusack, Paul Calleja, Antigona Hasani, Rajmonda Nallbani, Sylvia Daamen, Benoît Plichon, Pierre Harlet, Slama Farsi, Saman Sepehr, David Espinosa Espinosa,

Hip and Femur Fractures

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.