Association of Intraoperative Hemodynamic Instability and Myocardial Injury Biomarkers With Major Adverse Cardiovascular Events After Cardiac Surgery: A Prospective Cohort Study

Q: What are the key findings of this study?

Intraoperative hypotension duration (aOR 1.32; p=0.118) and peak hs-troponin (aOR 0.95; p=0.685) were not independently associated with 30-day MACE after cardiac surgery.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Elective or urgent cardiac surgery (CABG, valvular, or combined) (n=120). Intervention: Intraoperative hypotension duration (per 10-minute increase) and postoperative hs-troponin vs. Lower duration of intraoperative hypotension / no MACE group. Primary outcome: Major adverse cardiovascular events (MACE: composite of myocardial infarction, cardiac arrest, new or worsening heart failure, clinically significant arrhythmias, stroke, and cardiovascular death) within 30 days (OR 1.32, 95% CI 0.93–1.85, p=0.118).

Q: What does this research mean for the field?

Intraoperative hypotensive episodes occur more frequently in cardiac surgery patients who develop postoperative MACE, but neither cumulative hypotension duration nor postoperative myocardial injury biomarkers independently predict 30-day MACE. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Muhammad Yasir Khan; Danish Naveed; Noreen Atzaz

doi:10.25258/ijddt.16.86s.145

November 3, 2026International Journal of Drug Delivery TechnologyOpen Access

Association of Intraoperative Hemodynamic Instability and Myocardial Injury Biomarkers With Major Adverse Cardiovascular Events After Cardiac Surgery: A Prospective Cohort Study

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Key result

Intraoperative hypotension and peak hs-troponin are not associated with 30-day MACE after cardiac surgery.

OR 1.32
95% CI 0.93–1.85
P=0.118
n=120

Why the study?

Major adverse cardiovascular events remain important complications following cardiac surgery, and intraoperative hemodynamic instability and myocardial injury biomarkers may contribute to this postoperative cardiovascular risk. This study evaluated the association of these parameters with MACE among cardiac surgical patients.

Are intraoperative hemodynamic instability and postoperative myocardial injury biomarkers associated with 30-day major adverse cardiovascular events in adult patients undergoing elective or urgent cardiac surgery?

Key Points

To evaluate the association of intraoperative hemodynamic instability and postoperative myocardial injury biomarkers with 30-day major adverse cardiovascular events (MACE) following cardiac surgery.
Prospective observational cohort study of 120 patients undergoing cardiac surgery at two medical centers in Pakistan from January 2025 to January 2026.
Tracked intraoperative hemodynamics and measured postoperative high-sensitivity cardiac troponin and creatine kinase-MB during a 30-day follow-up for MACE.
Multivariable logistic regression and receiver operating characteristic curve analyses evaluated independent predictive factors and model discrimination.
MACE developed in 32 patients (26.7%), with hypotensive episodes occurring significantly more often in the MACE group compared with the non-MACE group (2.9 ± 1.7 vs. 2.2 ± 1.6; p=0.044).
Cumulative hypotension duration (aOR 1.32 per 10-minute increase; 95% CI 0.93–1.85; p=0.118) and peak postoperative troponin (aOR 0.95 per 1000 ng/L increase; 95% CI 0.75–1.21; p=0.685) were not independently associated with MACE.
The combined predictive model incorporating intraoperative hemodynamics and cardiac troponin demonstrated limited overall discrimination (AUC=0.620).

Study Design

Type

Cohort (n=120)

Multicenter

Yes

Structured PICO

Are intraoperative hemodynamic instability and postoperative myocardial injury biomarkers associated with 30-day major adverse cardiovascular events in adult patients undergoing elective or urgent cardiac surgery?

P

Population

120 adult patients (mean age 56.9 years, 33.3% female) undergoing elective or urgent cardiac surgery in Pakistan, excluding emergency cases, followed for 30 days.

E

Exposure

Evaluation of intraoperative hemodynamic instability (frequency and cumulative duration of hypotensive episodes defined as MAP < 65 mmHg during native circulation, lowest recorded MAP, and vasoactive drug use) and postoperative myocardial injury biomarkers (high-sensitivity cardiac troponin and creatine kinase-MB measured at baseline and within 6-12, 24, 48, and 72 hours postoperatively).

O

Outcome

Major adverse cardiovascular events (MACE) within 30 days after surgery, defined as a composite of clinically diagnosed myocardial infarction, cardiac arrest, new or worsening heart failure, clinically significant arrhythmias requiring therapeutic intervention, stroke, and cardiovascular death.composite

Main Result

Odds Ratio: 1.32 (95% CI 0.93–1.85)

p-value: p=0.118

In patients undergoing cardiac surgery, the frequency of intraoperative hypotensive episodes was higher among those developing 30-day MACE, but cumulative hypotension duration and postoperative myocardial injury biomarkers (hs-troponin and CK-MB) were not independently predictive of MACE after multivariable adjustment.

Limitations

Relatively small sample size (n=120)
Modest number of cardiovascular events (32 events)
Potential for residual confounding by baseline cardiac function and operative characteristics
Predictive models were evaluated on a synthetic dataset without internal or external validation
Relatively small sample size
Modest number of cardiovascular events
Potential for baseline cardiac function and operative characteristics to cause confounding
ROC estimates were based on a synthetic dataset / the same data used in model fitting and were not internally or externally validated
Non-probability consecutive sampling without a documented formal sample-size calculation

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Implication

Should not yet guide risk stratification or monitoring changes; leaves open whether intraoperative hemodynamics predict MACE in larger cardiac surgery cohorts.

Abstract

Background: Major adverse cardiovascular events (MACE) remain important complications following cardiac surgery. Intraoperative hemodynamic instability and myocardial injury biomarkers may contribute to postoperative cardiovascular risk. This study aimed to evaluate their association with MACE among cardiac surgical patients. Methods: This prospective observational cohort study included 120 patients undergoing cardiac surgery at Sardar Fateh Muhammad Khan Buzdar Institute of Cardiology, Dera Ghazi Khan, and Ayub Medical College, Abbottabad, Pakistan, from January 2025 to January 2026. Intraoperative hemodynamic parameters, postoperative high-sensitivity cardiac troponin, and creatine kinase-MB were evaluated. Patients were monitored for MACE during 30-day followup. Multivariable logistic regression assessed associated factors. Results: In the dataset, MACE occurred in 32 patients (26.7%). Hypotensive episodes were significantly more frequent among patients experiencing MACE (2.9 ± 1.7 versus 2.2 ± 1.6; p=0.044). Hypotension duration was greater in the MACE group, although statistically insignificant (p=0.073). Postoperative troponin and CK-MB concentrations showed no significant differences. Hypotension duration (aOR 1.32; p=0.118) and troponin (aOR 0.95; p=0.685) were not independently associated with MACE. The combined predictive model demonstrated limited discrimination (AUC=0.620). Conclusion: findings suggest that intraoperative hypotensive episodes may accompany postoperative cardiovascular complications, whereas myocardial injury biomarkers demonstrated limited independent predictive value. Larger prospective investigations using observed clinical data are necessary to establish reliable cardiovascular risk predictors and improve perioperative patient assessment and postoperative monitoring strategies.

Discussion

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Cite This Study

Khan et al. (2026) conducted a cohort in Elective or urgent cardiac surgery (CABG, valvular, or combined) (n=120). Intraoperative hypotension duration (per 10-minute increase) and postoperative hs-troponin vs. Lower duration of intraoperative hypotension / no MACE group was evaluated on Major adverse cardiovascular events (MACE: composite of myocardial infarction, cardiac arrest, new or worsening heart failure, clinically significant arrhythmias, stroke, and cardiovascular death) within 30 days (OR 1.32, 95% CI 0.93–1.85, p=0.118). Intraoperative hypotension duration (aOR 1.32; p=0.118) and peak hs-troponin (aOR 0.95; p=0.685) were not independently associated with 30-day MACE after cardiac surgery.

synapsesocial.com/papers/6aebc8cf3e63ca1b6c315f0d https://doi.org/10.25258/ijddt.16.86s.145

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Association of Intraoperative Hemodynamic Instability and Myocardial Injury Biomarkers With Major Adverse Cardiovascular Events After Cardiac Surgery: A Prospective Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association of Intraoperative Hemodynamic Instability and Myocardial Injury Biomarkers With Major Adverse Cardiovascular Events After Cardiac Surgery: A Prospective Cohort Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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