Incidence of major adverse cardiac events following non-cardiac surgery
Lorraine Sazgary, Christian Puelacher, Giovanna Lurati Buse, Noemi Glarner, Andreas Lampart, Daniel Bolliger, Luzius A. Steiner, Lorenz Gürke, Thomas Wolff, Edin Mujagić, Stefan Schaeren, Didier Lardinois, Jacqueline Espinola, Christoph Kindler, Angelika Hammerer‐Lercher, Ivo Strebel, Karin Wildi, Reka Hidvegi, Johanna Gueckel, Christina Hollenstein, Tobias Breidthardt, Katharina Rentsch, Andreas Buser, Danielle Menosi Gualandro, Christian Mueller, for the BASEL-PMI Investigators, Stella Marbot, Michael H. Walter, Thomas E. Freese, Jasper Nestelberger, Jeanne Boeddinghaus, Jeanne du Fay de Lavallaz, Patrick Twerenbold, Luca Badertscher, Tobias Koechlin, V. Zimmermann, Eleni Troester, Stefan Michou, Esther Osswald, Manfred D. Seeberger, Daniel Seeberger, Desiree Rickli, Julia Wussler, Alexandra Dinort, Kathrin Prepoudis, Gregor Meissner, R Fahrni, Christoph Jeger, Laura Kaiser, Infanti
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.