• W Scott Beattie, Manoj Lalu, Matthew Bocock, Simon Feng, Duminda N Wijeysundera, Peter Nagele, Lee A Fleisher, Andrea Kurz, Bruce Biccard, Kate Leslie, Simon Howell, Giovani Landoni, Hilary Grocott, Andre Lamy, Toby Richards, Paul Myles, StEP COMPAC Group, Patient Comfort, Clinical Indicators, Delirium Postoperative Cognitive Dysfunction Stroke, Cardiovascular, Data Extractors, Respiratory, Inflammation Sepsis, Acute Kidney Injury, Bleeding Complications Patient Blood Management, Healthcare Resource Utilisation, Patient-Centred Outcomes, Organ Failure and Survival, and Cancer Surgery.
• Cardiovascular Anesthesia, University Health Network, University of Toronto, Toronto, ON, Canada. Electronic address: scott.beattie@uhn.ca.
• Br J Anaesth. 2021 Jan 1; 126 (1): 566656-66.

BackgroundAdverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of standardised and valid cardiovascular outcomes for use in future perioperative clinical trials.MethodsWe identified currently used perioperative cardiovascular outcomes by a systematic review of the anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase, and Cochrane Library). We performed a three-stage Delphi consensus-gaining process that involved 55 clinician researchers worldwide. Cardiovascular outcomes were first shortlisted and the most suitable definitions determined. These cardiovascular outcomes were then assessed for validity, reliability, feasibility, and clarity.ResultsWe identified 18 cardiovascular outcomes. Participation in the three Delphi rounds was 100% (n=19), 71% (n=55), and 89% (n=17), respectively. A final list of nine cardiovascular outcomes was elicited from the consensus: myocardial infarction, myocardial injury, cardiovascular death, non-fatal cardiac arrest, coronary revascularisation, major adverse cardiac events, pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These nine cardiovascular outcomes were rated by the majority of experts as valid, reliable, feasible, and clearly defined.ConclusionsThese nine consensus cardiovascular outcomes can be confidently used as endpoints in clinical trials designed to evaluate perioperative interventions with the goal of improving perioperative outcomes.Copyright © 2020 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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