27% of patients with PMI after emergency surgery had cardiac complications, with over 50% occurring within 30 days, predicting high 1-year mortality (50.9% at 30 days).
Patients experiencing perioperative myocardial infarction or injury after emergency non-cardiac surgery face a 27% rate of subsequent cardiac complications, with more than half occurring within the first 30 days, highlighting the need for intensive postoperative monitoring.
Absolute Event Rate: 0% vs 0%
Abstract Background Perioperative myocardial infarction/injury (PMI) and major adverse cardiac events (MACE) determine clinical outcomes in patients undergoing non-cardiac surgery. Excess 30-day mortality and morbidity has been reported for emergency surgery that could not be sufficiently explained by preoperative variables and procedure type (1) and cardiac complications may be important contributors to these premature deaths (2,3). Purpose We aimed to determine the incidence of cardiac complications in patients undergoing emergency and urgent surgeries who suffered a PMI, their timing and phenotypes. Methods 3172 patients undergoing non-cardiac surgery in an emergency/urgency setting were prospectively included in the BASEL-PMI. Our outcomes were incidence of cardiac complications and all-cause death after PMI at 30 days and 1 year. We fitted a Cox proportional hazards model to estimate association between occurrence of cardiac complications and mortality and predictors like age, sex, Revised Cardiac Risk Index score, surgical discipline, centre and PMI etiology. Results Of the 567 patients who had a PMI after emergency/urgent surgeries, 153 (27%) experienced a cardiac complication among myocardial infarction, acute heart failure, life-threatening arrhythmias and cardiovascular death afterwards; 28 (4.9%) patients experienced more than one complication. The PMI etiology was type 1 in 17/153 (9,8%), tachyarrhythmia in 13/153 (8.5%), acute heart failure in 15/153 (9.8%), other/type 2 in 79/153 (51.6%)%, extracardiac in 29/153 (19%) and due to cardiac trauma in 1/153 (0.7%). Among patients who experienced a cardiac complication after PMI, it occurred within one month in 83/153 (54.2%, 95%CI 46.3-61.9) patients and within one year in 140/153 (91.4%, 95%CI 86.3-94.7) patients (Figure 1). Among patients who died after PMI, 89/175 (50.9%, 95%CI 43.5-58.2) died within the first 30 days and 160/175 (91.4%, 95%CI 86.3-94.7) within the first year (Figure 2). The Cox proportional hazards model identified older age and higher Revised Cardiac Risk Index score as positive predictors for both cardiac complications and death at one year. Conclusions the incidence of cardiac complications and mortality after a PMI in patients undergoing emergency and urgent surgeries is extremely high. Furthermore, our preliminary analyses show that rates of cardiac complications and mortality over 50% are observed within one month from surgery, suggesting a direct correlation to the perioperative period. Even if perioperative risk stratification is not feasible in the urgent setting, additional postoperative evaluation of patients experiencing a PMI is mandated to reduce the excess morbidity and mortality associated.Figure 1 Figure 2
Maiorano et al. (Sat,) reported a other. 27% of patients with PMI after emergency surgery had cardiac complications, with over 50% occurring within 30 days, predicting high 1-year mortality (50.9% at 30 days).
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