Outcomes in patients with chronic heart failure undergoing non-cardiac surgery: a secondary analysis of the METREPAIR international cohort study
- Autori: Kirkopoulos, Anna; M'Pembele, René; Roth, Sebastian; Stroda, Alexandra; Larmann, Jan; Gillmann, Hans-Joerg; Kotfis, Katarzyna; Ganter, Michael T; Bolliger, Daniel; Filipovic, Miodrag; Guzzetti, Luca; Mauermann, Eckhard; Ionescu, Daniela; Spadaro, Savino; Szczeklik, Wojciech; De Hert, Stefan; Beck-Schimmer, Beatrice; Howell, Simon J; Lurati Buse, Giovanna A;METREPAIR Investigators: Purificación Matute, Sanem Cakar Turhan, Judith van Waes, Filipa Lagarto, Kassiani Theodoraki, Anil Gupta, Alexey Ovezov, Biljana Kuzmanovska, Stjepan Barisin, Peter Poredos, Daniela Arabadzhieva, Dragana Unic-Stojanovic, Edith Fleischmann, Claude Meistelman, Donal J Buggy, Paul Calleja, Antigona Hasani Sebastian Roth, René M'Pembele, Johannes Nienhaus, Alexandra Stroda, Theresa Tenge, Anna Kirkopoulos, Ragnar Huhn, Detlef Kindgen-Milles, Cornelia Schultze, Nele Verbarg, Christian Gehrke, Anna Katharina Klemann, Friederike Hagebölling, Hans-Jörg Gillmann, Svenja Albrecht, Jakob Stroeder, Ann-Kristin Schubert, Hinnerk Wulf, Florian Espeter, Benedikt Russe, Jan Larmann, Markus A Weigand, Lars Bergmann, Matthias Unterberg, Petra Bischoff, Raphael Pirzer, Patric Rene Rach, Klaus Ott, Alexander Zarbock, Ana Kowark, Claudia Neumann, Bahareh Marchand, Christoph Sponholz, Henrik Rueffert, Mira Kramer, Simone Lindau, Patrick Meybohm, Kai Zacharowski, Götz Schmidt, Christian Koch, Melissa Carollo, Cecilia Novazzi, Fiorenza Toso, Alessandro Bacuzzi, Luca Guzzetti, Riccardo Ragazzi, Carlo Alberto Volta, Francesco De Giorgi, Barbara Bacer, Antonio Federico, Davide Chiumello, Luigi Vetrugno, Alberto Castella, Simonetta Tesoro, Antonella Cotoia, Elena Bignami, Agrippino Bellissima, Andrea Cortegiani, Marco Crisman, Arturo Toninelli, Ornella Piazza, Lucia Mirabella, Matteo Bossolasco, Francesco Bona, Juan Manuel Perdomo, Miquel Coca-Martinez, Albert Carramiñana, Marta Giné Servén, Astrid Batalla González, José Maria Gil Sánchez, Ángel Becerra-Bolaños, Aurelio Rodríguez-Pérez, Anna Artigas Soler, Morena Basso, Anna Peig Font, Diana Vernetta, Julia Hernando Santos, Enrique Alday Muñoz, Mercedes Cabellos Olivares, Gregorio Marco, Maria Bermudez Lopez, Javier Barrio, María Isabel Forés, Estefanía Boix, Mercedes Ayuso, Bogdan Sorel Petre, Ioana Sorina Oprea, Mihai Dan Latiș, Dan Corneci, Simona Margarit, Horatiu Vasian, Dana Tomescu, Iulia Cîndea, Dan Sebastian Dirzu, Sanda-Maria Copotoiu, Alida Moise, Serban Bubenek-Turconi, Liana Valeanu, Patrick Mark Wanner, Mirjana Djurdjevic, Sandra Nuth, Miodrag Filipovic, Esther Seeberger, Nicolai Goettel, Firmin Kamber, Eckhard Mauermann, Frederique Chammartin, Michael Thomas Ganter, Thomas Jan Gerber, Daniela Schneebeli, Andreas Pregernig, Beatrice Beck-Schimmer, Sina Grape, Simon Tomala, Bernardo Bollen Pinto, Maciej Żukowski, Małgorzata Zegan-Barańska, Igor Karolak, Katarzyna Kotfis, Lukasz Krzych, Szymon Czajka, Dorota Studzińska, Anna Kluzik, Tomasz Koszel, Izabela Pabjańczyk, Anna Gajdosz, Suheyla Karadag Erkoc, Basak Ceyda Meco, Ahmet Kemalettin Koltka, Muserref Beril Dincer, Perihan Ekmekçi, Kemal Tolga Saracoglu, Filiz Alkaya Solmaz, Menekse Ozcelik, Oguzhan Arun, Ozlem Korkmaz Dilmen, Benedikt Preckel, Markus W Hollmann, Yannick Hazen, Hans Donald de Boer, Anne Epema, Seppe Koopman, Felix Van Lier, Rita Pinto, André Carrão, Daniel Ribeiro, Joana Mourão, Miguel Coelho, Nuno Losa, Nuno Santos, Luis Cabral, Diana Afonso, Sérgio Zenha, Cristina Ramos, Carla Hipólito, Maria Vasilaki, Antonia Andreeva, Donika Zaimi, Athanasios Chalkias, Maria Spyraki, Martina Rekatsina, Georgia Tsaousi, Anthony Short, Sonja Meier, Thumuluru Kavitha Madhuri, Scott Latham, James Knock, Andrew Drummond, Fiona Ramsden, Kubisz-Pudelko, James Walker, Iain Moppett, Louise White, Simon J Howell, Matthew Jackson, Henrik Reschreiter, Richard Innes, Michelle Chew, Sigridur Kalman, Jakob Wallden, Anna Schening, Lina Jonikaite, Anna Enlund, Luc De Baerdemaeker, Stuart Morrison, Steffen Rex, Alexandros Alex
- Anno di pubblicazione: 2025
- Tipologia: Articolo in rivista
- OA Link: http://hdl.handle.net/10447/677345
Abstract
Introduction: Heart failure is a frequent comorbidity in patients undergoing non-cardiac surgery and an acknowledged risk factor for postoperative mortality. The associations between stable chronic heart failure and postoperative outcomes have not been explored extensively. The aim of this study was to determine associations between stable chronic heart failure and its peri-operative management and postoperative outcomes after major non-cardiac surgery. Methods: This is a secondary analysis of MET-REPAIR, an international prospective cohort study including patients undergoing non-cardiac surgery aged ≥ 45 y with increased cardiovascular risk. Main exposures were stable chronic heart failure and availability of a pre-operative transthoracic echocardiogram. The primary endpoint was the incidence of postoperative major adverse cardiovascular events at 30 days. Secondary endpoints included 30-day mortality and severe in-hospital complications. Multivariable logistic regression models were calculated. Results: Of 15,158 included patients, 3880 (25.6%) fulfilled the diagnostic criteria for stable chronic heart failure, of whom 1397 (36%) were female. Chronic heart failure was associated with increased risk of postoperative 30-day major adverse cardiovascular events (OR 2.04, 95%CI 1.59-2.60), 30-day mortality (OR 1.50, 95%CI 1.17-1.92) and in-hospital complications (OR 1.47, 95%CI 1.30-1.66). Transthoracic echocardiography was performed in 1267 (32.7%) patients with heart failure; 146 (11.5%) patients with heart failure presented with a left ventricular ejection fraction < 40%. Reduced ejection fraction was associated with major adverse cardiovascular events (OR 2.0, 95%CI 1.01-3.81). Discussion: Stable chronic heart failure is independently associated with major adverse cardiovascular events, mortality and severe postoperative complications when measured 30 days after non-cardiac surgery.