Association between self-reported functional capacity and major adverse cardiac events in patients at elevated risk undergoing noncardiac surgery: a prospective diagnostic cohort study

Author(s):Show less -

Buse, Giovanna A. L. Lurati ^[1] ; Puelacher, Christian ^[2] ; Gualandro, Danielle Menosi ^{[2, 3]} ; Genini, Alessandro S. ^{[2, 4]} ; Hidvegi, Reka ^{[2, 4]} ; Bolliger, Daniel ^[4] ; Arslani, Ketina ^[2] ; Steiner, Luzius A. ^[4] ; Kindler, Christoph ^[5] ; Mueller, Christian ^[2] ; Investigators, BASEL-PMI

Affiliation

^[1] Univ Hosp Dusseldorf, Anaesthesiol Dept, Dusseldorf - Germany

^[2] Univ Basel, Univ Hosp Basel, Dept Cardiol & Cardiovasc Res Inst Basel Crib, Basel - Switzerland

^[3] Univ Sao Paulo, Heart Inst InCor, Cardiol Dept, Interdisciplinary Med Cardiol Unit, Med Sch, Sao Paulo - Brazil

^[4] Univ Hosp Basel, Dept Anaesthesiol, Basel - Switzerland

^[5] Cantonal Hosp Aarau, Dept Anaesthesiol, Aarau - Switzerland

• Document type: Journal article
• Source: BRITISH JOURNAL OF ANAESTHESIA; v. 126, n. 1, p. 102-110, JAN 2021.
• Web of Science Citations: 1

Abstract

Background: Perioperative cardiovascular guidelines endorse functional capacity estimation, based on `cut-off' daily activities for risk assessment and climbing two flights of stairs to approximate 4 metabolic equivalents. We assessed the association between self-reported functional capacity and postoperative cardiac events. Methods: Consecutive patients at elevated cardiovascular risk undergoing in-patient noncardiac surgery were included in this predefined secondary analysis. Self-reported ability to walk up two flights of stairs was extracted from electronic charts. The primary endpoint was a composite of cardiac death and cardiac events at 30 days. Secondary endpoints included the same composite at 1 yr, all-cause mortality, and myocardial injury. Results: Among the 4560 patients, mean (standard deviation) age 73 (SD 8 yr) yr, classified as American Society of Anesthesiologists physical status >3 in 61% (n=2786/4560), the 30-day and 1-yr incidences of major adverse cardiac events were 5.7% (258/4560) and 11.2% (509/4560), respectively. Functional capacity less than two flights of stairs was associated with the 30-day composite endpoint (adjusted hazard ratio 1.63, 95% confidence interval {[}CI] 1.23-2.15) and all other endpoints. The addition of functional capacity information to the revised cardiac risk index (RCRI) significantly improved risk classification (functional capacity plus RCRI vs RCRI: net reclassification improvement {[}NRI](Events) 6.2 {[}95% CI 3.6-9.9], NRI(Nonevents)19.2 {[}95% CI 18.1-20.0]). Conclusions: In patients at high cardiovascular risk undergoing noncardiac surgery, self-reported functional capacity less than two flights of stairs was independently associated with major adverse cardiac events and all-cause mortality at 30 days and 1 yr. The addition of self-reported functional capacity to surgical and clinical risk improved risk classification. (AU)

• FAPESP's process: 15/23731-6 - Evaluation of high- sensitive troponin elevation and cardiovascular events after vascular surgery
• Grantee: Danielle Menosi Gualandro
• Support Opportunities: Regular Research Grants