Postoperative Cardiac Ischemic Complications in Lung Cancer Patients

Большедворская, О. А.; Протасов, К. В.; Батороев, Ю. К.; Улыбин, П. С.; Дворниченко, В. В.

doi:10.29413/abs.2019-4.5.15

Cited by 3 publications

(3 citation statements)

References 23 publications

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“…Эти факты отмечены и другими исследователями [10]. Среди важных клинических особенностей послеоперационного ИМ при раке легкого необходимо отметить описанный нами ранее очень высокий уровень госпитальной летальности -66,7% [5].…”

Section: Discussionunclassified

“…Здесь важно отметить, что 3 из 6 независимых предикторов ИМ (ЧСС после операции, минимальное интраоперационное систолическое АД и критерий гипертрофии ЛЖ) указывают на возможный механизм развития ИМ -несоответствие потребности миокарда в кислороде и его доставки в условиях хирургического стресса. Ранее нами было показано, что среди пациентов, умерших от ИМ, внутрикоронарный атеротромбоз инфарктсвязанной артерии был обнаружен только в 9,1% случаев [5]. Таким образом, полученные данные подтверждают мнение ряда авторов о преобладании 2 типа в структуре ИМ, ассоциированного с внесердечной хирургией [18].…”

Section: Discussionunclassified

“…Анализировали клинические проявления ИМ. Детальное описание изученной выборки, методов диагностики ИМ и статистического анализа на первом этапе исследования представлено нами ранее [5].…”

Section: материал и методыunclassified

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Postoperative myocardial infarction in lung cancer patients with: incidence rate, clinical features, prognostic factors

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Aim. To study the incidence, clinical features and predictors of postoperative myocardial infarction (MI) after lung cancer surgery.Material and methods. The retrospective analysis included 2051 patients (1373 males and 678 females, mean age, 65,5 [62-69] years), who underwent thoracotomy for non-small cell lung cancer. At the first stage, the incidence rate of postoperative MI (%) was calculated with 95% confidential interval (CI) in relation to sex, age and extent of surgery. At the second stage, the case-control study was carried out in groups with MI revealed on the first stage (n=33) and without MI (n=130), formed by individual criteria-based matching. A comparative intergroup analysis was performed and prognostic value of 60 clinical perioperative indicators was assessed by odds ratio (OR). The features associated with MI in the univariateregression model were introduced into multivariate stepwise logistic regression. Independent MI predictors was revealed.Results. The postoperative IM incidence rate amounted to 1,61 [0,67-1,76]%. MI was more frequently diagnosed in men than women (0,29%), and after pneumonectomy (3,92%) compared with less operative extent (0,37%). MI was associated with comorbidities, smoking intensity, right pneumonectomy, preoperative increase in white blood cells, neutrophils and monocytes, blood loss volume, surgery duration, postoperative heart rate, preoperative decrease in serum total protein, postoperative haemoglobin, haematocrit, red blood cells decrease, and intraoperative blood pressure (BP). By means of multivariate logistic regression, the following factors with most accurate MI prediction were established: postoperative heart rate (OR, 4,06 [95% CI 1,58-10,43]), Sokolow-Lyon index (OR, 1,54 [95% CI 1,14-2,07]), ACS-NSQIP value for cardiac complications (OR, 3,86 [95% CI 1,36-10,92]), preoperative serum total protein (OR, 0,17 [95% CI 0,040,71]) and white blood cells (CR 1,54 [95% CI 1,03-2,31]), minimal intraoperative systolic BP (OR, 0,35 [95% CI 0,15-0,83]).Conclusion. Postoperative MI incidence in lung cancer patients accounts for 1,61%. Following independent predictors for postoperative MI were established: Sokolow-Lyon index, preoperative serum total protein and leukocytes levels, ACS-NSQIP value, minimal intraoperative systolic BP and postoperative heart rate.

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Postoperative myocardial infarction in lung cancer patients with: incidence rate, clinical features, prognostic factors

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Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

Соколов

Lyuboshevsky

Староверов

et al. 2021

Vestn. anesteziol. reanimatol.

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The objective: to analyze the incidence and spectrum of cardiovascular complications within 12 months after noncardiac surgery, as well as to assess the association of preoperative values of various cardiac risk indices (CRI) and other potential risk factors with the actual development of complications.Subjects and Methods. We analyzed data of medical records and telephone interviews of 141 patients aged 65 [60-71] years who had undergone non-cardiac surgery a year before the interview The operations were low risk in 13.5% of observations, medium risk in 64.5%, and high risk in 22%. A retrospective calculation of the Revised CRI (RCRI), Individual CRI (Khoronenko CRI), and the American College of Surgeons Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) was performed.Results. Cardiac events (myocardial infarction, decompensation of chronic heart failure, new arrhythmias, stroke, and/or the need to prescribe or escalate the dose of cardiovascular drugs and/or hospitalization for cardiac indications, and/or death from cardiovascular diseases) within 12 months after elective noncardiac surgeries were detected in 27.7% of cases, and in 2.1% of patient's death occurred due to cardiac disorders. Predictors of cardiac events were concomitant ischemic heart disease (OR = 2.777; 95% CI 1.286-5.966; p = 0.0093) and chronic heart failure (OR = 2.900; 95% CI 1.224-6.869; p = 0, 0155), RCRI (OR = 1.886; 95% CI 1.2-8-2.944; p = 0.005), Khoronenko CRI (OR = 3254.3; 95% CI 64.33-164,638; p = 0.0001), MICA (OR = 1.628; 95% CI 1.156-2.292; p = 0.005), creatininemia on the first postoperative day (OR = 1.023; 95% CI 1.010-1.061; p = 0.005), and propensity for bradycardia during surgery (OR = 0.945; 95% CI 0.908-0.983; p = 0.005). Combined analysis of Khoronenko's CRI and postoperative creatininemia provided a very good model: area under the ROC-curve - 0.823 (95% CI 0.728-0.641; p = 0.0002).Conclusion. All studied CRIs can be used to predict posthospital cardiac events; however, the most promising is a joint assessment of Khoronenko's CRI and postoperative creatinemia.

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Assessment of the risk of cardiovascular complications in cancer surgery

Protasov

Bolshedvorskaya

2023

Acta biomedica scientifica

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Cardiac complications of non-cardiac surgeries are an actual and unresolved interdisciplinary problem of clinical medicine today. The incidence of cardiovascular events after non-cardiac surgery is higher than in the general population and does not tend to decrease. The risk of cardiac complications in cancer surgery is the highest. Evidence-based approaches to risk assessment and prevention of cardiovascular events in surgical patients with malignant neoplasms have not been developed. In current clinical guidelines on the prevention, prognosis and treatment of cardiac complications of non-cardiac surgeries, the aspects of this problem in surgical oncology are not considered separately.The aim of this review was to analyze the current sources of literature on the prediction of cardiovascular complications in surgical treatment of cancer patients. The distinctive features of cancer surgery and additional factors causing an increased risk of adverse cardiac outcomes in patients with malignant neoplasms are described. The article presents the results of large cohort studies on the search for reliable predictors of cardiac complications in non-cardiac surgery and on the development of stratification scales and algorithms for preoperative risk assessment. Particular attention is paid to the possibilities and prospects of using these predictive tools in the surgical treatment of cancer. The surgical risks of interventions for malignant neoplasms are described, as well as methods for calculating cardiac risk and functional status assessment that have been validated in oncological patients cohorts. The data of recent studies on the role of serum biomarkers of myocardial damage and increased cardiovascular risk (cardiac troponins and brain natriuretic peptide) in predicting postoperative cardiac events in non-cardiac surgery are presented. Further prospects for the inclusion of biomarkers in risk stratification systems in patients with malignant neoplasms are discussed.

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Postoperative Cardiac Ischemic Complications in Lung Cancer Patients

Cited by 3 publications

References 23 publications

Postoperative myocardial infarction in lung cancer patients with: incidence rate, clinical features, prognostic factors

Postoperative myocardial infarction in lung cancer patients with: incidence rate, clinical features, prognostic factors

Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

Assessment of the risk of cardiovascular complications in cancer surgery

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