Preoperative risk factors for cardiovascular events in non-cardiac surgery

Abstract

Aim. To identify preoperative factors associated with any cardiovas­cular events (AnyCVE), and to develop an AnyCVE risk index based on them.Material and methods. This single-center retrospective cohort study included patients who underwent non-cardiac surgery in 2018 and 2020. Depending on the outcomes, 2 groups of patients with AnyCVE and without AnyCVE at the hospital stage after non-cardiac surgeries were identified. A comparative analysis of >60 preoperative factors reflecting the patient's condition and elective surgical intervention was performed. An analysis of the associative relationship of preoperative indicators with the probability of AnyCVE was carried out; a prognostic model (PM) was built, based on which a simple risk index of AnyCVE was developed. We compared the quality of models based on the AnyCVE risk index (PM1) and the cardiac risk index (PM2).Results. A comparative analysis of the preoperative indicators of pa­tients with AnyCVE (n=392) and without AnyCVE (n=2545) revealed significant differences in a number of parameters that were analyzed for associations with the probability of AnyCVE. The following factors as­sociated with AnyCVE were identified: age ≥62 years, glucose level ≥5,59 mmol/l, C-reactive protein level ≥2,08 g/l, D-dimer ≥0,640 μg/ml, some noncommunicable diseases, surgical area, type of ane­sthe­sia, on the basis of which PM1 was developed. A simple AnyCVE index was formed as follows: the prognostic significance of each factor was as­ses­sed in points; the sum ≥4 was proposed to be regarded as a high risk of AnyCVE. In AnyCVE risk stratification, the prognostic value of the develo­ped PM1 (area under the curve of 0,862 with a 95% confidence interval of 0,721-1,000, sensitivity 69,2%, specificity 89,5%) exceeds PM2 based on the cardiac risk index criteria (area under the curve of 0,578 with a 95% confidence interval of 0,546-0,609, p<0,001, sensitivity 25,0%, specificity 90,4%).Conclusion. Preoperative factors that improve AnyCVE risk stratifica­tion in non-cardiac surgery are identified. A simple AnyCVE risk index is proposed for practical use.