Anaesthesiology Department, University Hospital Düsseldorf, Düsseldorf, Germany.
Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.
Br J Anaesth. 2021 Jan;126(1):102-110. doi: 10.1016/j.bja.2020.08.041. Epub 2020 Oct 17.
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.
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.
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] 6.2 [95% CI 3.6-9.9], NRI19.2 [95% CI 18.1-20.0]).
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.
INCT 02573532.
围手术期心血管指南支持根据“临界”日常活动进行功能能力评估，并评估爬两段楼梯以近似 4 代谢当量来评估风险。我们评估了自我报告的功能能力与术后心脏事件之间的关系。
本预先设定的二次分析纳入了处于心血管高风险并接受住院非心脏手术的连续患者。从电子图表中提取自我报告的上两段楼梯的能力。主要终点是 30 天内心脏死亡和心脏事件的综合结果。次要终点包括 1 年时相同的综合结果、全因死亡率和心肌损伤。
在 4560 例患者中，平均（标准差）年龄 73（8 岁）岁，61%（2786/4560）的美国麻醉医师协会身体状况分类为≥3 级，30 天和 1 年的主要不良心脏事件发生率分别为 5.7%（258/4560）和 11.2%（509/4560）。功能能力低于两段楼梯与 30 天的综合终点相关（调整后的危险比 1.63，95%置信区间 [CI] 1.23-2.15）和所有其他终点。将功能能力信息添加到修订后的心脏风险指数（RCRI）中可显著改善风险分类（功能能力加 RCRI 与 RCRI 相比：净重新分类改善 [NRI] 6.2 [95% CI 3.6-9.9]，NRI19.2 [95% CI 18.1-20.0]）。
在接受非心脏手术的高心血管风险患者中，自我报告的功能能力低于两段楼梯与 30 天和 1 年时的主要不良心脏事件和全因死亡率独立相关。将自我报告的功能能力与手术和临床风险相结合可改善风险分类。
INCT 02573532。
