Key result
Asymptomatic significant aortic stenosis did not significantly increase the risk of 30-day major adverse cardiovascular events compared to matched controls without aortic stenosis undergoing non-cardiac surgery.
Why the study?
There is a lack of research on the primary predictors of non-cardiac perioperative complications in patients with asymptomatic significant AS undergoing non-cardiac surgery.
Does asymptomatic significant aortic stenosis increase the risk of major adverse cardiovascular events in patients undergoing intermediate-to-high risk non-cardiac surgery?
Cohort (n=654)
No
Does asymptomatic significant aortic stenosis increase the risk of major adverse cardiovascular events in patients undergoing intermediate-to-high risk non-cardiac surgery?
Absolute Event Rate: 4.1% vs 3.9%
p-value: p=0.971
Asymptomatic significant aortic stenosis does not significantly increase 30-day major adverse cardiovascular events in patients undergoing intermediate-to-high risk non-cardiac surgery, though advanced cardiac damage stage is a strong predictor of perioperative risk.
Asymptomatic significant AS may not raise perioperative MACE risk versus controls; supports cardiac damage staging for risk stratification in prospective studies.
BACKGROUND Aortic valve stenosis (AS) is a representative geriatric disease, and there is an anticipated rise in the number of patients requiring non-cardiac surgeries in patients with AS. However, there is still a lack of research on the primary predictors of non-cardiac perioperative complications in patients with asymptomatic significant AS. METHOD AND RESULT Among the cohort of non-cardiac surgeries under general anesthesia, with an intermediate-to-high risk of surgery from 2011 to 2019, at Samsung Medical Center, 221 patients were identified to have asymptomatic significant AS. First, to examine the impact of significant AS on perioperative adverse events, the occurrences of Major Adverse Cardiovascular Events (MACE) and Perioperative Adverse Cardiovascular Events (PACE) were compared between patients with asymptomatic significant AS and the control group. Second, to identify the factors influencing the perioperative adverse events in patients with asymptomatic significant AS, multivariable logistic regression model was used. There was no significant difference between the three groups consisting of control group, moderate asymptomatic AS group, and severe asymptomatic AS group in the event rate of MACE (p value 0.971) and PACE (p value 0.185). Cardiac damage stage was significant risk factor of MACE (OR 9.241, 95% CI: 1.314 - 64.976, p-value = 0.025) and PACE (OR 2.199, 95% CI: 1.055 - 4.584, p-value = 0.036). CONCLUSION There was no significant difference in major post-operative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant AS is a key factor in perioperative risk of non-cardiac surgery. CLINICAL PERSPECTIVE What Is New? Advanced cardiac damage is a major risk factor for perioperative complications in non-cardiac surgeries of patients with asymptomatic significant AS. What Are the Clinical Implications? Patients with asymptomatic significant AS showed no significant difference in perioperative complications compared to the control group, but caution is needed in those with advanced cardiac damage, as they are more likely to experience adverse events.
No takes yet. Share an insight, caveat, or question.
Bak et al. (2023) conducted a cohort in Asymptomatic significant aortic stenosis (n=654). Asymptomatic significant aortic stenosis vs. Matched controls without significant aortic stenosis was evaluated on Major adverse cardiovascular events (MACE) within 30 days after surgery (p=0.971). Asymptomatic significant aortic stenosis did not significantly increase the risk of 30-day major adverse cardiovascular events compared to matched controls without aortic stenosis undergoing non-cardiac surgery.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: