Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study

초록

Background: Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during 30 -day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared longterm mortality with PACE using data from nationwide multicenter electronic health records. Methods: Data from 7 hospitals, converted to Observational Medical Outcomes Partnership Common Data Model, were used. We extracted records of 277,787 adult patients over 18 years old undergoing non -cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching and then an aggregated meta -analysis. Results: After 1:4 propensity score matching, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta -analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR]: 1.33, 95% CI [1.10, 1.60], P = 0.005) and higher three-year mortality (HR: 1.18, 95% CI [1.01, 1.38], P = 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher -risk surgical procedures (HR: 1.20, 95% CI [1.04, 1.39], P = 0.020 for low -risk surgery; HR: 1.69, 95% CI [1.45, 1.96], P < 0.001 for intermediate -risk; and HR: 2.38, 95% CI [1.47, 3.86], P = 0.034 for high -risk). Conclusions: A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger the older age group, emergency surgery group, and high surgical risk group. Further studies to improve mortality associated with PACE are needed.

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