Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica

Acta Academiae Medicinae Sinica ›› 2015, Vol. 37 ›› Issue (5): 541-548.doi: 10.3881/j.issn.1000-503X.2015.05.009

• Orginal Article • Previous Articles     Next Articles

Risk Factors of Perioperative Cardiac Events in Elderly Patients with Coronary Heart Disease Undergoing Non-cardiac Surgery

Zi-jia LIU1, Li XU1(), Chun-hua YU1, Hong ZHENG2, Shang-long YAO3, Ling PEI4, Li SUN5, Jing-mei JIANG6, Yu-guang HUANG1   

  1. 1Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
    2Department of Anesthesiology,the First Teaching Hospital of Xinjiang Medical University,Urumqi 830054,China
    3Department of Anesthesiology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China
    4 Department of Anesthesiology,the First Hospital of China Medical University,Shenyang 110001,China
    5 Department of Anesthesiology,Cancer Hospital,CAMS and PUMC,Beijing100021,China
    6 Department of Epidemiology and Statistics,Institute of Basic Medicine,CAMS and PUMC,Beijing 100005,China
  • Received:2015-03-10 Online:2015-10-15 Published:2015-10-31
  • Supported by:
    Supported by the Public Welfare Scientific Research Project,the Ministry of Health(200802030)

Abstract:

Objective To identify the incidence and risk factors of perioperative major adverse cardiac events(MACE)in elderly patients with coronary heart disease(CHD)undergoing non-cardiac surgery. Methods We prospectively analyzed the clinical data of 360 CHD patients who aged 75 years or older undergoing elective intermediate-to high-risk surgery in five medical centers across China from January 2008 to January 2010. The clinical variables included the 12-lead ECG and Troponin I levels after surgery. The combined outcome was defined as all the perioperative MACE in hospital. The risk factors of MACE and their indexes were analyzed with univariate analysis and multivariable logistic regression in SPSS software,together with a risk scoring and stratification system established. Results Perioperative MACE occurred in 11.94% of elderly CHD patients undergoing non-cardiac surgery. Seven independent risk factors of perioperative MACE for this population were identified,which included angina within 6 months(P=0.001),hypertension(P=0.014),preoperative haematocrit(HCT)<40%(P=0.050),serum creatinine(Scr)>150 mmol/L(P=0.014),ejection fraction(EF)<50%(P=0.019),intraoperative hyoxemia(P=0.019),and operative time>150 min(P=0.001). The risk indexes of these factors were 4,3,3,6,4,5,and 4,respectively. The rate of periopera- tive MACE increased significantly as the level of risk stratification elevated. Conclusions Elderly CHD patients undergoing non-cardiac surgery are at high risk of perioperative MACE. Angina within 6 months,hypertension,preoperative HCT<40%,Scr>150 mmol/L,EF<50%,intraoperative hyoxemia,and operative time>150 min can increase the risk of MACE. The risk scoring and stratification system based on the risk factor index can be a valuable parameter for assessing the perioperative cardiac risk of noncardiac surgery for elderly CHD patients.

Key words: elderly, coronary heart disease, non-cardiac surgery, cardiac events, risk factor

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