Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study
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; the MET-REPAIR investigators
(2024) British Journal of Anaesthesia, volume 132, issue 4, pp. 675 - 684
(Article)
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
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(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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Keywords: echocardiography, ejection fraction, guideline adherence, major adverse cardiovascular events, NT-proBNP, perioperative medicine, stress echocardiography, Anesthesiology and Pain Medicine
ISSN: 0007-0912
Publisher: Oxford University Press
Note: Publisher Copyright: © 2024 British Journal of Anaesthesia
(Peer reviewed)