Perioperative Cardiac Risk Assessment And Protective Factors In Elderly Patients With Coronary Heart Disease Undergoing Noncardiac Surgery

Background:Major cardiac adverse events (MACE) are important causes of perioperative morbidity and mortality in patients undergoing noncardiac surgery. For elderly patients with coronary heart disease (CHD), the incidence of perioperative MACE is much higher. Due to aging and CHD, the risk factors for them may be dramatically different from general population. However, there is no current literature focusing on perioperative MACE in elderly patients with CHD. In the growing elderly population with an increased CHD incidence, more attention should be paid on these patients to investigate the risk factors of perioperative MACE and the availability of protective measures.Objective:The purpose of this study was to identify the incidence and risk factors of perioperative MACE after noncardiac surgery for elderly patients with CHD, try to develop a risk assessment system to predict the perioperative MACE, and evaluate the protective value of related clinical treatments.Methods:It was a retrospective observational clinical study, including482consecutive medical records of elderly patients with CHD undergoing elective major noncardiac surgery in PUMCH. The combined outcome was defined as all the perioperative MACE in hospital. The risk factors of MACE and its index were analyzed with multivariable logistic regression in SPSS, together with a risk scoring and stratification system established. The protective value of every preoperative management was investigated in the whole study population and in all the levels of risk stratification respectively.Results:Perioperative MACE occurred in12.66%elderly patients with CHD undergoing noncardiac surgery. Five independent risk factors of perioperative MACE for this population were identified:①history of heart failure;②preoperative arrhythmia;③preoperative diastolic blood pressure≤75mmHg;①ASA classification≥class3and⑤intraoperative blood transfusion. The risk indexes of the factors were3,3,2,2,2 respectively. The risk index scoring system was proved to be an useful predictive parameter in Receiver Operating Characteristic (ROC) curve analysis. A risk stratification system was developed on the basis of the risk score. The rate of perioperative MACE increased significantly with the level of risk stratification elevated. Preoperative anticoagulant treatment and coronary revascularization could reduce the incidence of perioperative MACE for high-risk stratification elderly patients with CHD.Conclusions:Elderly patients with CHD were proved to be a high-risk population of perioperative MACE when undergoing noncardiac surgery. The risk scoring and stratification system based on the risk factor index of this study served as a valuable parameter to assess the perioperative cardiac risk of noncardiac surgery for elderly patients with CHD. Preoperative anticoagulant treatment was effective in improving cardiac outcomes for high-risk stratification elderly patients with CHD. Coronary revascularization seemed to be also beneficial for these patients.