What does this research mean for the field?

High-risk patients undergoing noncardiac surgery face a substantial rate of long-term adverse cardiac outcomes, which are strongly predicted by preexisting cardiovascular disease and acute postoperative ischemic events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

To assess the long-term cardiac prognosis of high-risk patients undergoing noncardiac surgery and identify predictors of adverse outcomes.

July 8, 1992JAMA

Long-term Cardiac Prognosis Following Noncardiac Surgery

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Population

444 patients with or at high risk for coronary artery disease who had undergone elective noncardiac surgery…

Design

Cohort

Follow-up

median 728 days

Authors

DMDennis T. ManganoCardiac Surgery

Discussion

Member takes

Implication

May warrant intensified surveillance after perioperative ischemic events; challenges consensus on transient risk and leaves open optimal management trials.

Key Points

To assess the long-term cardiac prognosis of high-risk patients undergoing noncardiac surgery and identify predictors of adverse outcomes.
Prospective cohort study involving 444 high-risk patients
Collected clinical and laboratory data during hospitalization and at 6 months, 1 year, and 2 years post-surgery
Analyzed data using proportional hazards models
11% of patients experienced major cardiovascular complications during a median follow-up of 728 days
Significant predictors of long-term outcomes included preexisting vascular disease (HR 6.1, p<0.0001) and postoperative myocardial infarction (HR 20, p<0.0001)
70% of adverse outcomes were preceded by in-hospital postoperative ischemia occurring at least 30 days prior.

Structured PICO

Population

444 patients with or at high risk for coronary artery disease who had undergone elective noncardiac surgery and were discharged from the hospital in stable condition.

Outcome

Composite of cardiac death, myocardial infarction, unstable angina, progressive angina requiring coronary artery bypass graft surgery or coronary angioplasty, and new unstable angina requiring hospitalizationcomposite

Patients surviving in-hospital perioperative ischemic events after noncardiac surgery are at a substantially increased risk for long-term adverse cardiac outcomes and warrant aggressive follow-up.

Cite This Study

Dennis T. Mangano (1992) studied this question.

synapsesocial.com/papers/6a1908c9a6ebdba58ad31939 https://doi.org/10.1001/jama.1992.03490020081035

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Implication

May warrant intensified surveillance after perioperative ischemic events; challenges consensus on transient risk and leaves open optimal management trials.

Long-term Cardiac Prognosis Following Noncardiac Surgery

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Long-term Cardiac Prognosis Following Noncardiac Surgery

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider