Poster No. 140 Major cardiovascular events in high cardiovascular risk patients submitted to non-cardiac surgery and its clinical determinants

Pre-operative cardiovascular assessment of patients with high ischaemic risk is fundamental to give the best perioperative management. Morbi-mortality is mainly due to patient-related risk and surgery-related risk. However, the risk scores are very heterogeneous and derived from non-cardiac populations, making them less accurate.

The study aims to characterize a cohort of patients with high ischemic risk who underwent non-cardiac surgery and to identify predictors of perioperative major adverse cardiovascular events (MACE) defined by urgent revascularization, myocardial infarction (MI) and/or cardiac death, thromboembolism and acute limb ischemia.

A single-center retrospective observational analysis between January 2015 and August 2022 evaluated 356 patients. Eligibility criteria included: patients with high cardiovascular risk with previous diagnosis of cardiac disease, planned to be submitted to high-risk non-cardiac surgery, and perioperative follow-up at our center.

A total of 356 patients with high cardiovascular risk undergoing NCS were eligible in the cohort. Perioperative MACE occurred in 4.5% of the patients. Predictors of MACE during perioperative period were older age (P < 0.001), chronic pulmonary disease (P = 0.031), coronary artery disease (CAD) (P = 0.011) and valvular heart disease (P = 0.039). Diabetes and hypertension exhibited a neutral impact in these patients.

These results highlight the increased thrombotic risk inherent to major surgery in patients with high risk cardiovascular disease. Older age, previous diagnosis of chronic pulmonary disease, coronary artery disease, and valvular heart disease are predictors of MACE in patients submitted to non-cardiac surgery, providing incremental value for predicting these events. More studies are needed to further caracterize this population.x