In patients with CHF diagnosis, New York Heart Association functional class was obtained by cardiologists. In cases with diagnostic uncertainty, B-type natriuretic peptide (BNP) or N-terminal proBNP levels were used if available. Preoperative chronic heart failure (CHF) was considered if there were clinical symptoms consistent with CHF regardless of left ventricular ejection fraction (LVEF), LVEF <50% assessed by echocardiography, or LVEF <45% assessed by gated single-photon emission computed tomography obtained during myocardial perfusion imaging. Previous coronary artery disease (CAD) was considered if the patient had history of MI, angina pectoris, or myocardial revascularization (coronary artery bypass graft surgery or percutaneous coronary intervention) or evidence of CAD on myocardial perfusion imaging (presence of fixed or reversible perfusion defects) or coronary angiography. The protocol was approved by the local ethics committees, and informed consent was not required. All screened patients are registered in a dedicated prospective database. The University Hospital of Basel has implemented a perioperative troponin screening in clinical routine since October 2014 in patients at high perioperative cardiovascular risk undergoing major noncardiac surgery. From October 2014 until October 2015, consecutive patients undergoing vascular surgery at Basel University Hospital, Switzerland, were included. In São Paulo, there is a special routine for patients undergoing arterial surgery in which patients are systematically seen by cardiologists before surgery. From September 2012 to March 2016, we included consecutive patients undergoing arterial vascular surgery at the Clinics Hospital, University of São Paulo Medical School, Brazil, for whom a preoperative cardiologic consultation was requested. For this analysis, individual patient data from two prospective cohorts were pooled. The Global Research on Acute Conditions Team (GREAT) Perioperative Initiative is an ongoing prospective international collaboration aiming to improve cardiovascular perioperative care.
Journal of Vascular Surgery Cases, Innovations and Techniques.Journal of Vascular Surgery: Venous and Lymphatic.
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