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)

Eun Kyoung Kim, Hong Mi Choi, Eui Young Choi, Hye Sun Lee, Goeun Park, Dong Woo Han, Sang Eun Lee, Chan Seok Park, Ji won Hwang, Jae Hyuk Choi, Mi Na Kim, Hyung Kwan Kim, Dae Hee Kim, Sung Hee Shin, Il Suk Sohn, Mi Seung Shin, Jin Oh Na, Iksung Cho, Sun Hwa Lee, Yong Hyun ParkTae Ho Park, Kye Hun Kim, Goo Young Cho, Hae Ok Jung, Dae Gyun Park, Ji Yeon Hong, Duk Hyun Kang

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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. Trial registration: The Clinical Research Information Service KCT0006279 for RCT and KCT0006280 for prospective cohort study. Registered on June 21, 2021.

Original languageEnglish
Article number776
JournalTrials
Volume23
Issue number1
DOIs
StatePublished - Dec 2022

Keywords

  • Echocardiography
  • Noncardiac surgery
  • Trial design

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