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Incidence of major adverse cardiac events following non-cardiac surgery.

Authors :: Sazgary L
Puelacher C
Lurati Buse G
Glarner N
Lampart A
Bolliger D
Steiner L
Gürke L
Wolff T
Mujagic E
Schaeren S
Lardinois D
Espinola J
Kindler C
Hammerer-Lercher A
Strebel I
Wildi K
Hidvegi R
Gueckel J
Hollenstein C
Breidthardt T
Rentsch K
Buser A
Gualandro DM
Mueller C
Source :: European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2021 Jun 30; Vol. 10 (5), pp. 550–558. Date of Electronic Publication: 2020 Oct 14.
Publication Year :: 2021
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.<br />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.<br />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.<br />Trial Registration: https://www.clinicaltrials.gov. Unique identifier: NCT02573532.<br /> (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.)