I read with interest the study by Ramos et al. on the ” Prognostic Value of Preoperative Electrocardiogram in Low-Risk Patients Undergoing Surgical Intervention and General Anesthesia”. The authors’ efforts to clarify the predictive efficacy of preoperative electrocardiography (ECG) in a population that appears to have a low-risk profile are meritorious. Nonetheless, I harbor concerns regarding the employed methodology, which may potentially impact the study’s findings.

Directly examining the hypothesis that an abnormal ECG can serve as a predictor of events is essential. This secondary analysis was incorporated by the authors within a subset of the population that underwent ECG. To robustly test their hypothesis, the primary analysis should have been whether an abnormal ECG is a predictor of increased risk compared to normal ECG findings. Implementing this methodology would yield a more precise assessment of the ECG’s ability to forecast postoperative complications.

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