PREDICTORS AND CASE FATALITY RATE OF PERIOPERATIVE MAJOR CARDIOVASCULAR EVENTS IN CARDIAC PATIENTS UNDERGOING NON-CARDIAC SURGERY.
Tématický okruh: Akutní stavy v kardiologii, Akutní koronární syndromy | |
| Typ: Ústní sdělení - lékařské , Číslo v programu: 386 | |
| Moťovská Z.1, Jarkovský J.2, Ondrakova M.1, Knot J.1, Havlůj L.3, Bartoška R.4, Bittner L.5, Gürlich R.6, Džupa V.4, Widimský P.1 1 III. interní-kardiologická klinika, 3. lékařská fakulta Univerzity Karlovy v Praze a Fakultní nemocnice Královské Vinohrady, Praha, 2 Institut biostatistiky a analýz, LF Masarykova Univerzita, Brno, 3 Chirurgická klinika, 3. lékařská fakulta Univerzity Karlovy v Praze a Fakultní nemocnice Královské Vinohrady,, 4 Ortopedicko-traumatologická klinika, 3. lékařská fakulta Univerzity Karlovy v Praze a Fakultní nemocnice Královské Vinohrady, 5 Urologická klinika, 3. lékařská fakulta Univerzity Karlovy v Praze a Fakultní nemocnice Královské Vinohrady, 6 Chirurgická klinika, 3. lékařská fakulta Univerzity Karlovy v Praze a Fakultní nemocnice Královské Vinohrady | |
Purpose. To identify predictors and case fatality rate of perioperative major adverse cardiovascular events (myocardial infarction, stroke, acute heart failure, venous thromboembolism, acute limb ischemia) in cardiac patients undergoing non-cardiac surgery. Methods. Analysis of prospective multicenter PRAGUE-14 study was performed. All consecutive (N 1200) cardiac patients, who were undergoing major non-cardiac surgery in a large university hospital from 1/2011 to 6/2013, were included. Results. MACEs occurred in 91 patients (7%), and 36 patients had more than 1 event. Age ≥75 years (OR (95% CI) 2.13 (1.36;3.33),p<0.001) and chronic pulmonary disease (1.89 (1.10;3.22),p=0.020) were significantly related to the risk of MACEs. Obesity was identified as a protective factor for the occurrence of MACE (0.55 (0.31;0.97),p=0.041). Risk of MACE was significantly higher in patients with valvular heart disease (1.72 (1.02;2.90), p=0.043), and in patients with ischemic heart disease (IHD) treated with PCI (1.67 (1.02;2.72),p=0.041). However, the latter was not found in patients, who had IHD treated with CABG (1.19 (0.66;2.16)). In-hospital mortality was 3.9% (in comparison to 0.9% in 17740 non-cardiac patients). Case fatality rate (CFR) of perioperative MACE was 37.4% (CFR of MI was 16.7%, stroke 100%, pulmonary embolism 58.3%, acute heart failure 48.3%, acute limb ischemia 18.2%). Risk of mortality in patients with (in comparison to patients without) MACE was (OR 95% CI) 61.00 (27.59;134.88),p<0.001. Conclusion. Case fatality rate of perioperative MACE in cardiac patients undergoing non-cardiac surgery is extremely high. Integration of identified predictors of these complications, which do not replicate known cardiovascular risk factors, into the perioperative cardiovascular risk assessment and decision-making process may improve prognosis of these patients. | |
