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Predictors and case fatality rate of perioperative major cardiovascular events in cardiac patients undergoing non-cardiac surgery.

Session Poster session 6

Speaker Zuzana Motovska

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Risk Factors and Prevention
  • Session type : Poster Session

Authors : Z Motovska (Prague,CZ), J Jarkovsky (Brno,CZ), M Ondrakova (Prague,CZ), J Knot (Prague,CZ), L Havluj (Prague,CZ), R Bartoska (Prague,CZ), L Bittner (Prague,CZ), R Gurlich (Prague,CZ), V Dzupa (Prague,CZ), R Grill (Prague,CZ), P Widimsky (Prague,CZ)

Z. Motovska1 , J. Jarkovsky2 , M. Ondrakova1 , J. Knot1 , L. Havluj1 , R. Bartoska1 , L. Bittner1 , R. Gurlich1 , V. Dzupa1 , R. Grill1 , P. Widimsky1 , 1Charles University Prague, 3rd Faculty of Medicine, Faculty Hospital Kralovske Vinohrady - Prague - Czech Republic , 2Institute of Biostatistics and Analyses of Masaryk University - Brno - Czech Republic ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 1125

Background: Preoperative risk-stratification to identify high-risk patients is used to improve perioperative management. The most-often used preoperative risk-stratification model was derived from a heterogeneous non-cardiac population, and prediction of cardiac events is notably less accurate for non-cardiac surgery patients.

Purpose: To identify predictors and case fatality rate (CFR) of perioperative major adverse cardiovascular events (myocardial infarction, stroke, acute heart failure, venous thromboembolism, acute limb ischemia) in cardiac patients undergoing non-cardiac surgery.

Methods: Analysis of prospective multicenter PRAGUE-14 study was performed. All consecutive (N 1200) cardiac patients, who were undergoing major non-cardiac surgery (general surgery, neurosurgery, trauma/orthopedic surgery, urologic surgery) in a large university hospital from 1/2011 to 6/2013, were included. This population represents 6.3% of the whole patient population (N 18,951), which was undergoing major non-cardiac surgery in the respective time-period. Demographic characteristics, cardiovascular risk factors, presence of cardiovascular diseases, significant comorbidity (presence of organ dysfunction, cancer), history of bleeding, type of surgery and long-term pharmacotherapy were included in the MACE prediction model.

Results: MACEs occurred in 91 patients (7%), and 36 patients had more than 1 event. Age ≥75 years (OR (95% CI) 2.13 (1.36; 3.33), p<0.001) and chronic pulmonary disease (1.89 (1.10; 3.22) p=0.020) were significantly related to the risk of MACEs. Diabetes (1.37 (0.88; 2.14)) and hypertension (0.69 (0.43; 1.11) had no influence on the risk of ischemic events. Obesity (BMI ≥30) was identified as a significant protective factor for the occurrence of ischemic complications (0.55 (0.31; 0.97), p=0.041). Risk of perioperative MACE was significantly higher in patients with valvular heart disease (1.72 (1.02; 2.90), p 0.043), and in patients with ischemic heart disease treated with PCI (1.67 (1.02; 2.72), p=0.041). However, the latter was not found in patients, who had ischemic heart disease treated with CABG (1.19 (0.66; 2.16). Long-term therapy with betablockers (1.01 (0.65; 1.56)) and statins (0.94 (0.59; 1.51) had no influence on the risk of MACE.

CFR of perioperative MACE was 37.4% (CFR of MI was 16.7%, stroke 100%, pulmonary embolism 58.3%, acute heart failure 48.3%, acute limb ischemia 18.2%). Risk of mortality in patients with (in comparison to patients without) MACE was (OR 95% CI) 61.00 (27.59; 134.88), p<0.001 (with ≥2 MACEs 84.23 (35.93; 197.46), p<0.001).

Conclusion: Case fatality rate of perioperative MACE in cardiac patients undergoing non-cardiac surgery is extremely high. Integration of identified predictors of these complications, which do not replicate known cardiovascular risk factors, into the perioperative cardiovascular risk assessment and decision-making process may improve prognosis of these patients.

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