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PRE-Operative ECHOcardiograhy for prevention of cardiovascular events after non-cardiac surgery in intermediate- and high-risk patients: protocol for a low-interventional, mixed-cohort prospective study design (PREOP-ECHO)open access

Authors
Kim, Eun KyoungChoi, Hong-MiChoi, Eui-YoungLee, Hye SunPark, GoeunHan, Dong WooLee, Sang-EunPark, Chan SeokHwang, Ji-wonChoi, Jae HyukKim, Mi-NaKim, Hyung-KwanKim, Dae-HeeShin, Sung-HeeSohn, Il SukShin, Mi-SeungNa, Jin OhCho, IksungLee, Sun HwaPark, Yong HyunPark, Tae-HoKim, Kye HunCho, Goo-YoungJung, Hae OkPark, Dae-GyunHong, Ji YeonKang, Duk-Hyun
Issue Date
14-9월-2022
Publisher
BMC
Keywords
Echocardiography; Noncardiac surgery; Trial design
Citation
TRIALS, v.23, no.1
Indexed
SCIE
SCOPUS
Journal Title
TRIALS
Volume
23
Number
1
URI
https://scholar.korea.ac.kr/handle/2021.sw.korea/145752
DOI
10.1186/s13063-022-06701-2
ISSN
1745-6215
Abstract
Background: Cardiac evaluation using transthoracic echocardiography before noncardiac surgery is common in real-world practice. However, evidence supporting preoperative echocardiography is lacking. This study aims to evaluate the additional benefit of preoperative echocardiography in predicting postoperative cardiovascular events (CVE) in noncardiac surgery. Methods: This study is designed as a multicenter, prospective study to assess the utility of preoperative echocardiography in patients undergoing intermediate- or high-risk noncardiac surgery. This trial comprises two studies: (1) a randomized controlled trial (RCT) for patients undergoing intermediate-risk surgery with fewer than three clinical risk factors from the revised cardiac risk index (intermediate-risk group) and (2) a prospective cohort study for patients undergoing intermediate-risk surgery with three or more clinical risk factors, or who undergo high-risk surgery regardless of the number of clinical risk factors (high-risk group). We hypothesize that the use of preoperative echocardiography will reduce postoperative CVEs in patients undergoing intermediate- to high-risk surgery through discovery of and further intervention for unexpected cardiac abnormalities before elective surgery. A total of 2330 and 2184 patients will be enrolled in the two studies. The primary endpoint is a composite of all-cause death; aborted sudden cardiac arrest; type I acute myocardial infarction; clinically diagnosed unstable angina; stress-induced cardiomyopathy; lethal arrhythmia, such as sustained ventricular tachycardia or ventricular fibrillation; and/or newly diagnosed or acutely decompensated heart failure within 30 days after surgery. Discussion: This study will be the first large-scale prospective study examining the benefit of preoperative echocardiography in predicting postoperative CVE. The PREOP-ECHO trial will help doctors identify patients at risk of postoperative CVE using echocardiography and thereby reduce postoperative CVEs.
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