Predictors of long‐term mortality and cardiac events in patients with known or suspected coronary artery disease who survive major non‐cardiac surgery

Abstract

SummaryThe aim of this prospective study was to assess predictors of long-term outcome in patients with documented or suspected coronary artery disease who survive major non-cardiac surgery. The impact of patients' comorbidities, pre-operative heart rate variability and postoperative increase in cardiac troponin I on all-cause mortality and major cardiac events within 2 years was explored using multivariable logistic regression. Six of 173 patients died within the first month after surgery and were excluded from the study. Thirty-four of 167 patients (20%) died 1-24 months after surgery. Independent predictors of all-cause mortality were history of congestive heart failure (odds ratio 6.4 [95%, confidence interval 1.7-24]), pre-operatively depressed heart rate variability (odds ratio 6.4 [95%, confidence interval 1.9-21]), and age > 70 years (odds ratio 4.5 [95%, confidence interval 1.2-16]). In contrast, postoperative elevation of cardiac troponin I did not independently predict all-cause mortality or major cardiac events.

Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review

“…26,27,29,30 The authors of one of the studies 27 published a second paper evaluating the same patients but excluding deaths in the first month after surgery and extending the follow-up period from 1 to 2 years. 31 In this second paper, an elevated perioperative troponin value did not significantly predict the few deaths between months 1 to 24 after surgery (odds ratio 2.7, 95% CI 0.7-10), 31 which suggests that an elevated perioperative troponin value more strongly predicts mortality in the first 12 months after surgery. We did not evaluate the short-term predictive power of troponin or CK-MB values for diagnosing MI because they are now part of the diagnostic criteria.…”

Does heart rate variability predict hypotension and bradycardia after induction of general anaesthesia in high risk cardiovascular patients?*

“…The activity of the autonomic nervous system is reflected in the heart rate variability (HRV) [6][7][8]. Several authors have demonstrated depressed long-term HRV in patients with underlying cardiovascular disease [9][10][11] and HRV has proved to be highly predictive for cardiovascular morbidity and mortality in these patients [12][13][14]. Recently, short-term HRV analysis (5 min) has been shown to be a reliable tool to predict hypotension after spinal anaesthesia [15,16].…”

Use of heart rate variability analysis to determine the risk of cardiac ischaemia in high‐risk patients undergoing general anaesthesia

“…This may result in an inferior predictive value of LF ⁄ HF in patients with underlying cardiovascular disease. In two recent studies, Filipovic et al demonstrated that LF ⁄ HF < 2.0 was an independent risk factor of longterm mortality, cardiac events, and all-cause mortality after major non-cardiac surgery [7,26]. We tested LF ⁄ HF < 2 for prediction of postoperative cardiac events, but the sensitivity and specificity were low.…”

“…The predictive value of TP was superior for prediction of long as well as short-term cardiovascular events compared with LF ⁄ HF 2.5 (TP 400 ms 2 .Hz : sensitivity 76%, specificity: 88%, p < 0.05 vs LF ⁄ HF 2.5: sensitivity 93%, specificity: 36%, p = 0.07) and LF ⁄ HF 2.0 (LF ⁄ HF 2.0: sensitivity 83%, specificity: 52%, p = 0.07). Threshold values of LF ⁄ HF were tested to compare our results with recently published data [7]. Sensitivity and specifity were inferior compared with TP.…”

“…Specifically, depressed time domain parameters and low total power (TP) of HRV during 24 h continuous analysis proved to be highly predictive for cardiovascular morbidity and mortality in patients with coronary artery disease [7][8][9]. Recently, it has been demonstrated that in patients undergoing surgery shortterm HRV analysis (5 min) is a reliable tool to predict hypotension after spinal anaesthesia [10,11].…”