Rates of Cardiovascular Complications Following Surgery Higher than Previously Thought

Christian Puelacher, MD, PhD

New data from an analysis of patients admitted for surgery at a hospital in Switzerland suggests risk of major adverse cardiovascular events (MACE) following non-cardiac surgery could be cause for concern.

An observational study of more than 2000 high-risk patients admitted for non-cardiac surgery between October 2014 and November 2015, results of the study indicate more than 20% went on to develop at least one cardiovascular condition within the first year after surgery.

"People who undergo major surgery are increasingly old and have other diseases, and these are the patients we focused on in our study. By providing information on postoperative complications, our research provides opportunities to make surgery even safer,” said lead investigator Christian Puelacher, MD, PhD, of the University of Basel, Switzerland, in a statement.

To more fully understand the incidence and timing of postoperative MACE, Puelacher and a team from the University Hospital Basel sought to examine trends within patients at the University Hospital Basel. Using the aforementioned time period, investigators identified a cohort of 2265 consecutive patients for inclusion in the current study.

To be considered high-risk, investigators required patients to be 65 years of age or older or be at least 45 years of age with a history of cardiovascular disease. Investigators pointed surgeries included in the analysis were visceral, orthopedic, trauma, vascular, urologic, spinal, and thoracic procedures and all patients included in the study stayed at least one night.

As part of the study design, all patients included underwent a cardiac troponin-based screening for preoperative myocardial infarction/injury (PMI) and MACE. Patients were followed for 12 months to assess the occurrence of cardiovascular disease, acute heart failure, hemodynamically relevant arrhythmias, spontaneous myocardial infarction, and PMI.

Among the entire study cohort, which had a mean age of 73 years and was 43.4% women, the incidence of MACE at 30 days was 15.2% and incidence at 365 days was 20.6%. Results suggested cardiovascular disease occurred in 1.2% (95% CI, 0.9-1.8) and in 3.7% (95% CI, 3.0-4.5), hemodynamically relevant arrhythmias in 1.2% (95% CI, 0.9-1.8) and in 2.1% (95% CI, 1.6-2.8), acute heart failure 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.

Based on the results of the study, investigators determined the MACE incidence was increased above the presumed baseline rate until 135 days after surgery, which would suggest a vulnerable period of 3-5 months.

"Our results indicate that this high-risk patient group has an elevated likelihood of having an adverse cardiac event for three to five months after major surgery," added Puelacher, in the aforementioned statement.

This study, “Incidence of major adverse cardiac events following non-cardiac surgery,” was published in the European Heart Journal—Acute Cardiovascular Care.