Key result
Positive dobutamine stress echocardiography strongly predicted perioperative major adverse cardiac events compared to negative results (36% vs 4%; OR 12.4, 95% CI 2.3-67, P=0.003).
Why the study?
Does dobutamine stress echocardiography predict perioperative MACE in patients with cardiac risk factors and reduced exercise capacity undergoing major non-cardiac surgery?
Cohort (n=79)
No
Does dobutamine stress echocardiography predict perioperative MACE in patients with cardiac risk factors and reduced exercise capacity undergoing major non-cardiac surgery?
Effect estimate: OR 12.4 (95% CI 2.3-67)
Absolute Event Rate: 36% vs 4%
p-value: p=0.003
A negative dobutamine stress echocardiogram has a high negative predictive value (96%) for perioperative MACE in patients with cardiac risk factors undergoing major non-cardiac surgery.
May support selective perioperative risk stratification with DSE; leaves open need for prospective validation before practice change.
BACKGROUND: Guidelines recommend functional testing for myocardial ischaemia in the perioperative setting in patients with greater than one recognised cardiac risk factor and self-reported reduced exercise capacity. AIM: To determine the clinical utility of dobutamine stress echocardiography (DSE) for perioperative risk stratification in patients undergoing major non-cardiac surgery. METHODS: Data on 79 consecutive patients undergoing DSE for perioperative risk stratification at a single centre were retrospectively reviewed to determine rates of major adverse cardiac events (MACE) during the index hospitalisation and 30 days post-discharge. Echocardiography and outcome data were obtained through a folder audit and echolab database. RESULTS: Out of the 79 DSE performed for perioperative risk stratification, 11 (14%) were positive (DSE +ve) and 68 (86%) were negative (DSE -ve). Management in the DSE +ve group included medical optimisation without invasive intervention (n = 7(64%)), diagnostic coronary angiography (n = 3(27%)) and coronary artery bypass graft (n = 1(9%)). None of the patients underwent percutaneous coronary intervention preoperatively. Perioperative MACE in the DSE +ve group was 36% compared to 4% in the DSE-ve group (P = 0.006). DSE +ve was a powerful predictor of perioperative inpatient MACE (OR 12.4, 95% CI 2.3-67, P = 0.003). The positive predictive value of DSE +ve status was 36%, whereas the negative predictive value of DSE-ve status for perioperative MACE was 96%. CONCLUSION: DSE for perioperative risk stratification had a high clinical utility in patients undergoing major non-cardiac surgery. In particular, a normal DSE had a high negative predictive value for perioperative MACE.
No takes yet. Share an insight, caveat, or question.
Go et al. (2017) conducted a cohort in Patients with cardiac risk factors and reduced exercise capacity undergoing major non-cardiac surgery (n=79). Positive dobutamine stress echocardiography (DSE +ve) vs. Negative dobutamine stress echocardiography (DSE -ve) was evaluated on Perioperative major adverse cardiac events (MACE) (OR 12.4, 95% CI 2.3-67, p=0.003). Positive dobutamine stress echocardiography strongly predicted perioperative major adverse cardiac events compared to negative results (36% vs 4%; OR 12.4, 95% CI 2.3-67, P=0.003).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: