Incidence of major adverse cardiac events following non-cardiac surgery

• Published in: European heart journal. Acute cardiovascular care 2021-06, Vol.10 (5), p.550–558-558
• Main Authors: Sazgary, Lorraine, Puelacher, Christian, Lurati Buse, Giovanna, Glarner, Noemi, Lampart, Andreas, Bolliger, Daniel, Steiner, Luzius, Gürke, Lorenz, Wolff, Thomas, Mujagic, Edin, Schaeren, Stefan, Lardinois, Didier, Espinola, Jacqueline, Kindler, Christoph, Hammerer-Lercher, Angelika, Strebel, Ivo, Wildi, Karin, Hidvegi, Reka, Gueckel, Johanna, Hollenstein, Christina, Breidthardt, Tobias, Rentsch, Katharina, Buser, Andreas, Gualandro, Danielle M, Mueller, Christian
• Format: Article
• Language: English
• Subjects: Original Scientific Papers
• ISSN: 2048-8726; 2048-8734; 2048-8734
• DOI: 10.1093/ehjacc/zuaa008

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. 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. 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. https://www.clinicaltrials.gov. Unique identifier: NCT02573532.