One in five high-risk patients who undergo major, non-cardiac surgery develops one or more heart complications within a year, researchers report today.
The proportion at risk, says the research published yesterday (14 October 2020) in European Heart Journal – Acute Cardiovascular Care, is higher than previously believed and patients are also at risk for longer.
The study, led by the University of Basel, Switzerland, included high-risk patients aged 65 to 85, and those aged 45 to 64 with cardiovascular disease.
All 2,265 of the participants, whose average age was 73, had non-cardiac surgery that required at least one night’s hospital stay following their procedure and they were followed for one year after surgery for heart attacks, heart failure, heart rhythm disorders, and death due to cardiovascular disease. To detect asymptomatic heart attacks, all patients also had troponin measurements taken while in hospital.
The researchers found that 15% had at least one heart complication within 30 days and this was highest in patients who had thoracic surgery (22%), followed by vascular surgery (21%) and trauma surgery (19%). One in five patients (21%) had at least one heart complication within one year.
Study author Dr Christian Puelacher of the University of Basel said: “This was one of the first studies to monitor patients for asymptomatic heart attacks after surgery. These patients were at greater risk of subsequent events.
“One-third of patients who had an asymptomatic heart attack went on to have at least one more heart complication, compared to just 10% of those who did not have an asymptomatic heart attack. Our study suggests that measuring troponin levels before surgery and for two days afterwards could identify these patients and provide an opportunity to prevent further complications and death.”
Most complications occurred within the first 30 days after surgery – and mainly in the first week – but the study identified a vulnerable period of up to five months.
“Our results indicate that this high-risk patient group has an elevated likelihood of having an adverse cardiac event for three to five months after major surgery,” said Dr Puelacher.
He noted, however, that the study did not investigate what patients can do to improve their outcomes.
Sazgary L, Puelacher C, Lurati Buse G et al. Incidence of major adverse cardiac events following non-cardiac surgery. Eur Heart J Acute Cardiovasc Care 15 October 2020; doi:10.1093/ehjacc/zuaa008.
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