Shulman et al considered several measures for evaluating a patient prior to major surgery. These can help to predict prognosis. The authors are from Alfred Hospital, Monash University, Sunnybrook Health Sciences Centre, Toronto General Hospital and Queen Mary University in Australia, Canada and England.

Patient selection: adult prior to major surgery


Outcomes: 30-day mortality or myocardial infarction; 12-month mortality



(1) 6-minute walk test (6-MWT) in meters

(2) serum NT-proBNP in pg/mL


6-MWT in meters


< 435


435 to 510


> 510




• A low 6-MWT and elevated serum NT-proBNPis associated with the worst outcomes.

• A high 6-MWT and low serum NT-proBNP is associated with the best outcomes.

• The authors also found the Duke Activity Status Index (DASI) useful in predicting disability-free survival (DFS).



• The area under the ROC curve for 6-MWT is 0.70 for 30-day and 0.66 for 12-month outcomes.

• The area under the ROC curve for serum NT-proBNP is 0.67 for 30-day and 0.71 for 12-month outcomes.

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