Key result
Perioperative cardiac complications occur in ~19% of octogenarians with CAD undergoing noncardiac surgery.
Why the study?
Noncardiac surgeries are increasingly performed in patients aged 80 years or older with coronary artery disease, but the incidence and risk factors of perioperative cardiac complications in this oldest-old population had not been evaluated previously.
Cohort (n=547)
No
Elderly patients (>80 years) with CAD undergoing noncardiac surgery face a high risk of perioperative cardiac complications, driven by factors such as recent angina, poor functional capacity, untreated hypertension, and prolonged anesthesia.
PURPOSE: Ever-increasing noncardiac surgeries are performed in patients aged 80 years or over with coronary artery disease (CAD). The objective of the study was to explore the incidence and risk factors of perioperative cardiac complications (PCCs) for the oldest-old patients with CAD undergoing noncardiac surgery, which have not been evaluated previously. PATIENTS AND METHODS: A total of 547 patients, aged over 80 years, with a history of CAD who underwent noncardiac surgery were enrolled in this retrospective study. Perioperative clinical variables were extracted from the electronic medical records database. The primary outcome was the occurrence of PCCs intraoperatively or within 30 days postoperatively, defined as any of the following complications: acute coronary syndrome, heart failure, new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac death. Multivariate logistic regression analysis and multivariate Cox regression model were both performed to estimate the risk factors of PCCs. The incidence of PCCs overtime was illustrated by the Kaplan-Meier curve with a stratified Log-rank test. RESULTS: ; the history of angina within 6 months; metabolic equivalents <4; hypertension without regular treatment; preoperative ST-T segment abnormality; anesthesia time >3 h and drainage ≧200 mL within 24 h postoperatively. CONCLUSION: The incidence of PCCs in elderly patients over 80 years with CAD who underwent noncardiac surgery was high. Comprehensive preoperative evaluation, skilled surgical technique, and regular postoperative monitoring may help to reduce the occurrence of PCCs in this high-risk population.
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Liu et al. (2020) conducted a cohort in Coronary Artery Disease (CAD) (n=547). Perioperative clinical and surgical risk factors (e.g., age ≥85, BMI ≥30, anesthesia >3h) vs. Absence of these risk factors was evaluated on Occurrence of perioperative cardiac complications intraoperatively or within 30 days postoperatively. The incidence of perioperative cardiac complications was 19.4% in patients over 80 with coronary artery disease undergoing noncardiac surgery, strongly associated with 8 independent risk factors.
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