title: Incidence and predictors of major perioperative adverse cardiac and cerebrovascular events in non-cardiac surgery.
abstract: BACKGROUND
  Major adverse cardiac and cerebrovascular events (MACCE) represent the most common cause of serious perioperative morbidity and mortality. Our aim was to identify risk factors for MACCE in a broad surgical population with intermediate-to-high surgery-specific risk and to build and validate a model to predict the risk of MACCE.
  
  
  METHODS
  A prospective, multicentre study of patients undergoing surgical procedures under general or regional anaesthesia in 23 hospitals. The main outcome was the occurrence of at least one perioperative MACCE, defined as any of the following complications from admittance to discharge: cardiac death, cerebrovascular death, non-fatal cardiac arrest, acute myocardial infarction, congestive heart failure, new cardiac arrhythmia, angina, or stroke. The MACCE predictive index was based on β-coefficients and validated in an external data set.
  
  
  RESULTS
  Of 3387 patients recruited, 146 (4.3%) developed at least one MACCE. The regression model identified seven independent risk factors for MACCE: history of coronary artery disease, history of chronic congestive heart failure, chronic kidney disease, history of cerebrovascular disease, preoperative abnormal ECG, intraoperative hypotension, and blood transfusion. The area under the receiver-operating characteristic curve was 75.9% (95% confidence interval, 71.2-80.6%).
  
  
  CONCLUSIONS
  The risk score based on seven objective and easily assessed factors can accurately predict MACCE occurrence after non-cardiac surgery in a population at intermediate-to-high surgery-specific risk.
authors: Department of Anaesthesiology, Fundació Puigvert (IUNA), Carrer Cartagena 340, 08025 Barcelona, Spain. 29285sst@comb.cat
authors: S
authors: S
authors: Sabaté
authors: A
authors: A
authors: Mases
authors: N
authors: N
authors: Guilera
authors: J
authors: J
authors: Canet
authors: J
authors: J
authors: Castillo
authors: C
authors: C
authors: Orrego
authors: A
authors: A
authors: Sabaté
authors: G
authors: G
authors: Fita
authors: F
authors: F
authors: Parramón
authors: P
authors: P
authors: Paniagua
authors: A
authors: A
authors: Rodríguez
authors: M
authors: M
authors: Sabaté
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D004562:Electrocardiography; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors