Key result
Adding preoperative TTE parameters to clinical risk factors improves perioperative cardiac complication prediction over RCRI.
Why the study?
Guidelines do not recommend routine transthoracic echocardiography (TTE) before noncardiac surgery, so its predictive value for perioperative cardiac complications in elderly CAD patients remains unclarified.
Does a combined clinical and preoperative TTE prediction model improve discrimination of perioperative cardiac complications compared to the Revised Cardiac Risk Index in elderly patients with CAD undergoing noncardiac surgery?
Cohort (n=2,204)
No
Does a combined clinical and preoperative TTE prediction model improve discrimination of perioperative cardiac complications compared to the Revised Cardiac Risk Index in elderly patients with CAD undergoing noncardiac surgery?
Combining preoperative echocardiographic parameters with clinical risk factors significantly improves the prediction of perioperative cardiac complications in elderly patients with coronary artery disease.
May enhance PCC risk stratification in elderly CAD patients; leaves open need for prospective validation of the nomogram.
Purpose: Guidelines have not recommended routine transthoracic echocardiography (TTE) for elderly patients prior to noncardiac surgery. We aimed to evaluate the significance of preoperative TTE to predict perioperative cardiac complications (PCCs) for elderly patients with coronary artery disease (CAD) undergoing noncardiac surgery. Patients and methods: We retrospectively reviewed 2204 patients over 65 years of age with CAD who underwent TTE before intermediate- or high-risk noncardiac surgery in a teaching hospital in China between September 2013 and August 2019. The revised cardiac risk index (RCRI) was assessed. PCCs comprised acute coronary syndrome, heart failure, new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac death. Logistic regression was used to build the prediction model for PCCs. Discrimination was evaluated using receiver operating characteristic curves, and a nomogram of the predictive model was constructed. Results: PCCs occurred in 189 (8.6%) patients. Multivariable analysis showed that eight clinical risk factors (age, history of myocardial infarction, insulin therapy for diabetes, New York Heart Association classification, preoperative serum creatinine, preoperative electrocardiogram ST-T abnormality and pathological Q wave, and American Society of Anesthesiologists classification) and five TTE parameters (left atrial anteroposterior dimension, left ventricular ejection fraction, left ventricular diastolic dysfunction, pulmonary hypertension, and regional ventricular wall motion abnormality) were associated with PCCs. The receiver operating characteristic curve for the clinical plus TTE model provided better discrimination for PCCs compared with the RCRI model (area under the curve: 0.731 vs 0.564; P < 0.001) and the clinical model (area under the curve: 0.731 vs 0.697, P = 0.001), respectively. The clinical plus TTE model was presented as a prognostic nomogram. Conclusion: Preoperative TTE may help predict PCCs in elderly patients with CAD undergoing noncardiac surgery, and the prognostic nomogram from this study appeared to be useful for the assessment of perioperative cardiac risk.
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Liu et al. (2022) conducted a cohort in Coronary artery disease in elderly patients undergoing noncardiac surgery (n=2,204). Clinical plus transthoracic echocardiography (TTE) prediction model vs. Revised cardiac risk index (RCRI) model was evaluated on Perioperative cardiac complications (PCCs) intraoperatively or within 30 days postoperatively (AUC 0.731, 95% CI 0.691-0.771, p=<0.001). A prediction model combining clinical factors and preoperative transthoracic echocardiography parameters provided better discrimination for perioperative cardiac complications compared to the RCRI model (AUC 0.731 vs 0.564, p<0.001).
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