Cardiac Events after Noncardiac Surgery in Patients Undergoing Preoperative Dobutamine Stress Echocardiography

Findings From the Mayo Poce-DSE Investigators

R. Jay Widmer, Michael W. Cullen, Bradley R. Salonen, Karna K. Sundsted, David Raslau, Arya Mohabbat, Brian M. Dougan, D. Mike Bierle, Donna K. Lawson, A. Jimmy Widmer, Mary Bundrick, Prakriti Gaba, Rene Tellez, Darrell R. Schroeder, Robert B. McCully, Karen F. Mauck

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
DOIs
StateAccepted/In press - Jan 1 2018

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Stress Echocardiography
Research Personnel
Confidence Intervals
Heart Arrest
Medical Records
Mortality
Myocardial Infarction
Metabolic Equivalent
Ambulatory Surgical Procedures
Demography

Keywords

  • Dobutamine stress echocardiography
  • Perioperative medicine
  • Surgical outcomes

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cardiac Events after Noncardiac Surgery in Patients Undergoing Preoperative Dobutamine Stress Echocardiography : Findings From the Mayo Poce-DSE Investigators. / Widmer, R. Jay; Cullen, Michael W.; Salonen, Bradley R.; Sundsted, Karna K.; Raslau, David; Mohabbat, Arya; Dougan, Brian M.; Bierle, D. Mike; Lawson, Donna K.; Widmer, A. Jimmy; Bundrick, Mary; Gaba, Prakriti; Tellez, Rene; Schroeder, Darrell R.; McCully, Robert B.; Mauck, Karen F.

In: American Journal of Medicine, 01.01.2018.

Research output: Contribution to journalArticle

Widmer, RJ, Cullen, MW, Salonen, BR, Sundsted, KK, Raslau, D, Mohabbat, A, Dougan, BM, Bierle, DM, Lawson, DK, Widmer, AJ, Bundrick, M, Gaba, P, Tellez, R, Schroeder, DR, McCully, RB & Mauck, KF 2018, 'Cardiac Events after Noncardiac Surgery in Patients Undergoing Preoperative Dobutamine Stress Echocardiography: Findings From the Mayo Poce-DSE Investigators', American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2017.12.025
Widmer, R. Jay ; Cullen, Michael W. ; Salonen, Bradley R. ; Sundsted, Karna K. ; Raslau, David ; Mohabbat, Arya ; Dougan, Brian M. ; Bierle, D. Mike ; Lawson, Donna K. ; Widmer, A. Jimmy ; Bundrick, Mary ; Gaba, Prakriti ; Tellez, Rene ; Schroeder, Darrell R. ; McCully, Robert B. ; Mauck, Karen F. / Cardiac Events after Noncardiac Surgery in Patients Undergoing Preoperative Dobutamine Stress Echocardiography : Findings From the Mayo Poce-DSE Investigators. In: American Journal of Medicine. 2018.
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abstract = "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.",
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T2 - Findings From the Mayo Poce-DSE Investigators

AU - Widmer, R. Jay

AU - Cullen, Michael W.

AU - Salonen, Bradley R.

AU - Sundsted, Karna K.

AU - Raslau, David

AU - Mohabbat, Arya

AU - Dougan, Brian M.

AU - Bierle, D. Mike

AU - Lawson, Donna K.

AU - Widmer, A. Jimmy

AU - Bundrick, Mary

AU - Gaba, Prakriti

AU - Tellez, Rene

AU - Schroeder, Darrell R.

AU - McCully, Robert B.

AU - Mauck, Karen F.

PY - 2018/1/1

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N2 - 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.

AB - 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.

KW - Dobutamine stress echocardiography

KW - Perioperative medicine

KW - Surgical outcomes

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