Perioperative medicine & outcomes
Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study
Authors' conclusion
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.
Study context
- Population
- Patients undergoing preoperative cardiac evaluation in the international MET-REPAIR cohort39% female
- Participants
- 15,529 patients
- Comparison
- ESC 2022 vs 2014 guideline recommendations for preoperative cardiac testing (TTE, stress imaging)
- Primary endpoint
- Reduced ejection fraction (EF<40%), stress-induced ischaemia, and MACE
Methodological detailsinternational, second-order Monte Carlo simulations, multivariable regression
- International
- Second-order Monte Carlo simulations
- Multivariable regression
Primary result
As reported in the abstract
2022 update changed recommendation for preoperative TTE
39.7%
2022 update changed recommendation for preoperative stress imaging
12.9%
Missed EF <40% per fewer conducted TTE
1 every 3
Additional stress imaging per additionally detected ischaemia event
4 per 1
Further findings
NT-proBNP use for risk estimation
- Did not improve the yield of pathological findings
Original publication
Pathological findings associated with the updated European Society of Cardiology 2022 guidelines for preoperative cardiac testing: an observational cohort modelling study. Br J Anaesth. Published 9 February 2024. doi:10.
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