Incidence of major adverse cardiac events following non-cardiac surgery

Abstract

Aims Major adverse cardiac events (MACE) triggered by non-cardiac surgery are prognostically important perioperative complications. However, due to often asymptomatic presentation, the incidence and timing of postoperative MACE are incompletely understood. Methods and results We conducted a prospective observational study implementing a perioperative screening for postoperative MACE [cardiovascular death (CVD), acute heart failure (AHF), haemodynamically relevant arrhythmias, spontaneous myocardial infarction (MI), and perioperative myocardial infarction/injury (PMI)] in patients at increased cardiovascular risk (≥65 years OR ≥45 years with history of cardiovascular disease) undergoing non-cardiac surgery at a tertiary hospital. All patients received serial measurements of cardiac troponin to detect asymptomatic MACE. Among 2265 patients (mean age 73 years, 43.4% women), the incidence of MACE was 15.2% within 30 days, and 20.6% within 365 days. CVD occurred in 1.2% [95% confidence interval (CI) 0.9–1.8] and in 3.7% (95% CI 3.0–4.5), haemodynamically relevant arrhythmias in 1.2% (95% CI 0.9–1.8) and in 2.1% (95% CI 1.6–2.8), AHF in 1.6% (95% CI 1.2–2.2) and in 4.2% (95% CI 3.4–5.1), spontaneous MI in 0.5% (95% CI 0.3–0.9) and in 1.6% (95% CI 1.2–2.2), and PMI in 13.2% (95% CI 11.9–14.7) and in 14.8% (95% CI 13.4–16.4) within 30 days and within 365 days, respectively. The MACE-incidence was increased above presumed baseline rate until Day 135 (95% CI 104–163), indicating a vulnerable period of 3–5 months. Conclusion One out of five high-risk patients undergoing non-cardiac surgery will develop one or more MACE within 365 days. The risk for MACE remains increased for about 5 months after non-cardiac surgery. Trial registration https://www.clinicaltrials.gov. Unique identifier: NCT02573532.

Perioperative cardiovascular outcome in patients with coronary artery disease undergoing major vascular surgery: A retrospective cohort study

“…Early multicenter cohort studies reported in the past 2 decades have shown an incidence of MACE ranging from 1% to 7% in noncardiac surgeries comprising a large variety of surgeries and patients with widely different preoperative cardiac risks. [ 4 12 13 14 ] The incidence of 11.3% cardiac events that we report is, however, less than the 15.2% reported by Sazgary et al ,[ 5 ] wherein the focus was on noncardiac surgeries done in high-risk patients similar to our cohort; they found a high incidence of MACE in vascular surgeries, second only to thoracic surgeries. Their markedly higher incidence could be due to the older age group of patients in their cohort, median age of 73 years, inclusion of emergency surgeries with inadequate preoperative optimization, and an improved screening method for MACE.…”

“…[ 10 ] Hemodynamically relevant arrhythmias were defined as cardiac arrest, sustained ventricular tachycardia, atrial fibrillation with the need of treatment, and atrioventricular block III. [ 5 ] Cardiovascular death included death attributable to PMI, sudden cardiac arrest, acute heart failure, stroke, cardiovascular procedure, and pulmonary embolism. [ 11 ] Secondary outcome parameters such as duration of mechanical ventilation, need for tracheostomy, duration of ICU stay and hospital stay, the incidence of acute kidney injury and stroke, and in-hospital mortality were noted.…”

“…[ 3 ] Vascular surgeries in particular have been shown to contribute to a large proportion of perioperative cardiac events. [ 4 5 ] In addition to the surgical morbidity, the incidence of coronary artery disease (CAD) per se in these patients has been verified to be significantly high, as supported by the presence of common risk factors for CAD and aortic aneurysms. [ 6 7 ]…”

Managing Cardiac Patients: Dentists’ Knowledge, Perceptions, and Practices

“… 49 Little is known about cardiac complications following invasive dental interventions in women. Following non-cardiac surgery, limited evidence suggests that there are no sex differences in major adverse cardiac events 50 ; however, the literature is evolving and many issues remain to be firmly established, 51 , 52 including the effect of sex on patients’ risk. In general, women with cardiac disease experience greater morbidity and mortality compared to men.…”

Risk of post-operative cardiovascular event in elderly patients with pre-existing cardiovascular disease who are undergoing hip fracture surgery

“…Other researchers have also reported that Chinese patients who had any pre-existing MI or stroke were 2.87 times (Hazard ratio, HR = 2.872, 95% CI: 1.503–5.487) more likely to have a subsequent CVD event in 3 years [ 6 ]. In another study, for patients who received major surgical operations, peri-operative MI increased the risk of subsequent major adverse cardiac events (MACE) by 70% in the following year [ 7 ]. A study among hip fracture patients reported that patients with pre-existing heart failure had a higher one year post-operative heart failure exacerbation (HR = 3.00, 95% CI: 2.32–3.87) and one year mortality (HR = 2.11, 95% CI: 1.67–2.67) compared to those who did not have underlying or pre-existing heart conditions [ 8 ].…”