Cardiac Events after Noncardiac Surgery in Patients Undergoing Preoperative Dobutamine Stress Echocardiography: Findings From the Mayo Poce-DSE Investigators.

Autor:	Widmer RJ; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn., Cullen MW; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn., Salonen BR; Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minn., Sundsted KK; Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minn., Raslau D; Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minn., Mohabbat AB; Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minn., Dougan BM; Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minn., Bierle DM; Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minn., Lawson DK; Department of Internal Medicine, Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minn., Widmer AJ; Department of Internal Medicine, Baylor Scott and White Health, Central Texas, Texas., Bundrick M; AbbVie, Inc., Chicago, Ill., Gaba P; Mayo Medical School, Rochester, Minn., Tellez R; General Surgery Residency Program, University of California, Irvine., Schroeder DR; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn., McCully RB; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn., Mauck KF; Department of Internal Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, Minn. Electronic address: Mauck.karen@mayo.edu.
Jazyk:	angličtina
Zdroj:	The American journal of medicine [Am J Med] 2018 Jun; Vol. 131 (6), pp. 702.e15-702.e22. Date of Electronic Publication: 2018 Jan 17.
DOI:	10.1016/j.amjmed.2017.12.025
Abstrakt:	Background: Current guidelines support the use of dobutamine stress echocardiography (DSE) prior to noncardiac surgery in higher-risk patients who are unable to perform at least 4 metabolic equivalents of physical activity. We evaluated postoperative outcomes of patients in different operative risk categories after preoperative DSE. Methods: We collected data from the medical record on 4494 patients from January 1, 2006 to December 31, 2011 who had DSE up to 90 days prior to a noncardiac surgery. Patients were divided into low, intermediate, and high preoperative surgery-specific risk. Baseline demographic data and risk factors were abstracted from the medical record, as were postoperative cardiac events including myocardial infarction, cardiac arrest, and mortality within 30 days after surgery. Results: There were 103 cardiac outcomes (2.3%), which included myocardial infarction (n = 57, 1.3%), resuscitated cardiac arrest (n = 26, 0.6%), and all-cause mortality (n = 40, 0.9%). Cardiac event rates were 0.0% (95% confidence interval [CI], 0.0%-3.9%) in the low-surgical-risk group, 2.1% (95% CI, 1.6%-2.5%) in the intermediate-surgical-risk group, and 3.4% (95% CI, 2.0%-4.4%) in the high-risk group. Thirty-day postoperative mortality rates were 0%, 0.9%, and 0.8% for the low-risk, intermediate-risk, and high-risk surgical groups, respectively, and were not statistically different. Conclusions: These findings demonstrate low cardiac event rates in patients who underwent a DSE prior to noncardiac surgery. The previously accepted construct of low-, intermediate-, and high-risk surgeries based on postoperative events of <1%, 1%-5%, and >5% overestimates the actual risk in contemporary settings. (Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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