Major adverse cardiac events in elderly patients with coronary artery disease undergoing noncardiac surgery: A multicenter prospective study in China.
BACKGROUND
Major adverse cardiac events (MACEs) are important causes of perioperative morbidity and mortality for elderly patients undergoing non-cardiac surgery. Treatment and control rates for coronary artery disease (CAD) in Chinese patients are poorer than rates in western countries. However, no previous prospective study has focused on perioperative MACE in this population. Our aim was to ascertain the incidence and risk factors associated with MACEs in Chinese patients.


METHODS
Consecutive CAD patients, aged ≥60 years, who underwent non-cardiac surgery at five medical centers in China, were prospectively enrolled. Clinical variables, including electrocardiogram and troponin I levels, were evaluated to estimate MACEs. The main outcome was occurrence of at least one perioperative MACE from admittance to 30 days after surgery, defined as any of the following complications: cardiac death, nonfatal cardiac arrest, acute myocardial infarction (MI), congestive heart failure (CHF), and angina. MACE independent risk factors were based on the Andersen-Gill multiplicative intensity model.


RESULTS
Of the 1422 patients recruited, 129 (9.1%) developed at least one MACE, and cardiac death occurred in 11 patients (0.8%). The independent risk factors contributing to postoperative MACE included age ≥75 years, female gender, history of MI, history of hypertension, high-risk surgery, intraoperative hypotension, and intraoperative hypoxemia.


CONCLUSIONS
The incidence of MACE in Chinese elderly patients with CAD who underwent non-cardiac surgery was 9.1%. Seven independent risk factors for a perioperative MACE were identified. Preventing intraoperative hypoxemia and hypotension may reduce the occurrence of MACE in these high risk patients.
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Li
L
Xu
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Chunhua
C
Yu
Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences, Beijing, China.
Jingmei
J
Jiang
Department of Anesthesiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.
Hong
H
Zheng
Department of Anesthesiology,Union Hospital, Tong Ji Medical College, Huazhong University of Science & Technology, Wuhan, Hubei, China.
Shanglong
S
Yao
Department of Anesthesiology, First Affiliated Hospital of China Medical University Graduate School, Shenyang, Liaoning, China.
Ling
L
Pei
Department of Anesthesiology, Cancer Hospital of Chinese Academy of Medical Sciences, Beijing, China.
Li
L
Sun
Department of Epidemiology and Biostatistics, Institute of Basic Medical Science, Chinese Academy of Medical Sciences, Beijing, China.
Fang
F
Xue
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China. Electronic address: pumchgary@163.com.
Yuguang
Y
Huang
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology; D002681:China; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure; D006801:Humans; D015994:Incidence; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications; D011184:Postoperative Period; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
Aging; Coronary artery disease; Major adverse cardiac events (MACE); Morbidity; Risk factors; Surgery