Incidence and predictors of major perioperative adverse cardiac and cerebrovascular events in non-cardiac surgery
S Sabaté, A Mases, N Guilera, J Canet, J Castillo, C Orrego, A Sabaté, G Fita, F Parramón, P Paniagua, A Rodríguez, M Sabaté, ANESCARDIOCAT Group, Beatriz Martin, Maite Rivilla, Marta Giné, Marc Sadurní, Miriam Fau, Raquel Arroyo, Amèlia Rojo, Elisenda Pujol Rosa, Irene Rovira, Amalia Alcón, Marta Lacambra, Albert Pi, Diana Campello, Pilar Sierra, Ana Arnal, Covadonga Llorente, Valentin Mazo, Silvia Lopez, Novella Calo, M Jesús Laso, M Angels Subirana, Janete Andrade, Guillem Brugal, Olga Ramiro, Teresa Vilalta, Gràcia Cárdenas, Carmen Hernández, Xavier March, Alfred Muñoz, Albert Canadell, Lisette Jiménez, Gentxo Balev, Carmen Martín, Jordi Serrat, Laura Mahillo, Joan Fornaguera, Lluis Martinez, María Paz Villalba, Dolors del Pozo, Fabián Ibañez, Antonio Garcés, Alfonso Alonso, S Sabaté, A Mases, N Guilera, J Canet, J Castillo, C Orrego, A Sabaté, G Fita, F Parramón, P Paniagua, A Rodríguez, M Sabaté, ANESCARDIOCAT Group, Beatriz Martin, Maite Rivilla, Marta Giné, Marc Sadurní, Miriam Fau, Raquel Arroyo, Amèlia Rojo, Elisenda Pujol Rosa, Irene Rovira, Amalia Alcón, Marta Lacambra, Albert Pi, Diana Campello, Pilar Sierra, Ana Arnal, Covadonga Llorente, Valentin Mazo, Silvia Lopez, Novella Calo, M Jesús Laso, M Angels Subirana, Janete Andrade, Guillem Brugal, Olga Ramiro, Teresa Vilalta, Gràcia Cárdenas, Carmen Hernández, Xavier March, Alfred Muñoz, Albert Canadell, Lisette Jiménez, Gentxo Balev, Carmen Martín, Jordi Serrat, Laura Mahillo, Joan Fornaguera, Lluis Martinez, María Paz Villalba, Dolors del Pozo, Fabián Ibañez, Antonio Garcés, Alfonso Alonso
Abstract
Background: Major adverse cardiac and cerebrovascular events (MACCE) represent the most common cause of serious perioperative morbidity and mortality. Our aim was to identify risk factors for MACCE in a broad surgical population with intermediate-to-high surgery-specific risk and to build and validate a model to predict the risk of MACCE.
Methods: A prospective, multicentre study of patients undergoing surgical procedures under general or regional anaesthesia in 23 hospitals. The main outcome was the occurrence of at least one perioperative MACCE, defined as any of the following complications from admittance to discharge: cardiac death, cerebrovascular death, non-fatal cardiac arrest, acute myocardial infarction, congestive heart failure, new cardiac arrhythmia, angina, or stroke. The MACCE predictive index was based on β-coefficients and validated in an external data set.
Results: Of 3387 patients recruited, 146 (4.3%) developed at least one MACCE. The regression model identified seven independent risk factors for MACCE: history of coronary artery disease, history of chronic congestive heart failure, chronic kidney disease, history of cerebrovascular disease, preoperative abnormal ECG, intraoperative hypotension, and blood transfusion. The area under the receiver-operating characteristic curve was 75.9% (95% confidence interval, 71.2-80.6%).
Conclusions: The risk score based on seven objective and easily assessed factors can accurately predict MACCE occurrence after non-cardiac surgery in a population at intermediate-to-high surgery-specific risk.
Source: PubMed