Perioperative Cardiovascular Research Articles

Correction to: 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Correction to: 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology - 2024.

Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology - 2024.

Dynamic Perioperative Platelet Activity and Cardiovascular Events in Peripheral Artery Disease

ObjectivePatients with peripheral artery disease (PAD) undergo lower extremity revascularization (LER) for symptomatic relief or limb salvage. Despite LER, patients remain at increased risk of platelet-mediated complications, such as major adverse cardiac and limb events (MACLE). Platelet activity is associated with cardiovascular events; yet little is known about the dynamic nature of platelet activity over time. We therefore investigated the change in platelet activity over time and its association with long-term cardiovascular risk. MethodsPatients with PAD undergoing LER were enrolled into the multicenter, prospective Platelet Activity and Cardiovascular Events (PACE) study. Platelet aggregation was assessed by light transmission aggregometry (LTA) to submaximal epinephrine (0.4μ M) immediately prior to LER, and on post-operative day 1 or 2 (POD1) and 30 (POD30). A hyperreactive platelet phenotype was defined as >60% aggregation. Patients were followed longitudinally for MACLE, defined as the composite of death, myocardial infarction, stroke, major lower extremity amputation, or acute limb ischemia leading to reintervention. ResultsAmong 287 patients undergoing LER, mean age was 70 ± 11 years, 33% were female, 61% were white, and 89% were on baseline antiplatelet therapy. Platelet aggregation to submaximal epinephrine induced a bimodal response; 15.5%, 16.8%, and 16.4% of patients demonstrated a hyperreactive platelet phenotype at baseline, POD1, and POD30, respectively. Platelet aggregation increased by 18.5% (P=0.001) from baseline to POD1, which subsequently returned to baseline at POD30. After a median follow-up of 19 months, MACLE occurred in 165 (57%) patients. After adjustment for demographics, clinical risk factors, procedure type, and antiplatelet therapy, platelet hyperreactivity at POD1 was associated with a significant hazard of long-term MACLE (aHR 4.61, 95% CI 2.08-10.20, P<0.001). ConclusionAmong patients with severe PAD, platelet activity increases following LER. Platelet hyperreactivity to submaximal epinephrine on POD1 is associated with long-term MACLE. Platelet activity following LER may represent a modifiable biomarker associated with excess cardiovascular risk.

2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.

The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.

Perioperative cardiovascular and cerebrovascular outcomes in recipients of ECMO bridge to lung transplant

BackgroundThe use of ECMO as bridge to lung transplant (BTT) has increased over time. While one-year and overall survival have been reported to be similar with non-ECMO transplant recipients, there are limited data major adverse cardiovascular and cerebrovascular events (MACCE) and clinically relevant bleeding (CRB) events. In this study we sought to evaluate the incidence of perioperative MACCE and CRB in lung transplant recipients who underwent ECMO BTT. MethodsUsing the National Inpatient Sample from 2008 to 2019, we identified 5,254 lung transplant recipients who either received or did not require pre-transplant ECMO. Perioperative MACCE and CRB were compared between the two cohorts. ResultsPatients with ECMO BTT had a higher incidence of MACCE compared to non-ECMO patients (35% vs. 13.3%, p <0.0001) and CRB (34.5% vs 12.9%, p <0.0001). Recipients of pre-transplant ECMO for double lung transplant (n=158) were more likely to have perioperative MACCE and CRB as opposed to patients without pre-transplant ECMO (n=3,584) (adjusted odds ratio 2.69, p <0.0001; 95% CI 1.86-3.80). The ECMO BTT cohort were notably younger with less cardiac comorbidities and higher diagnoses of cystic fibrosis and ILD. ConclusionOur data indicate that lung transplant recipients who required ECMO BTT are at significantly higher risk of MACCE and bleeding events despite being younger with less comorbidities as opposed to those who did not require ECMO.

Evolution of a Large Language Model for Preoperative Assessment Based on the Japanese Circulation Society 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery.

Background: The Japanese Circulation Society 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery standardizes preoperative cardiovascular assessments. The present study investigated the efficacy of a large language model (LLM) in providing accurate responses meeting the JCS 2022 Guideline. Methods and Results: Data on consultation requests, physicians' cardiovascular records, and patients' response content were analyzed. Virtual scenarios were created using real-world clinical data, and a LLM was then consulted for such scenarios. Conclusions: Google BARD could accurately provide responses in accordance with the JCS 2022 Guideline in low-risk cases. Google Gemini has significantly improved its accuracy in intermediate- and high-risk cases.

Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology – 2024

Guideline for Perioperative Cardiovascular Evaluation of the Brazilian Society of Cardiology – 2024

Multidisciplinary Team Discussion and Shared Decision Making Recommended in JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-cardiac Surgery

Multidisciplinary Team Discussion and Shared Decision Making Recommended in JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-cardiac Surgery

JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery.

JCS 2022 Guideline on Perioperative Cardiovascular Assessment and Management for Non-Cardiac Surgery.

The Relevance of Implementing the Systematic Screening of Perioperative Myocardial Injury in Noncardiac Surgery Patients.

Perioperative myocardial injury (PMI) is a common cardiac complication. Recent guidelines recommend its systematic screening using high-sensitivity cardiac troponin (hs-cTn). However, there is limited evidence of local screening programs. We conducted a prospective, single-center study aimed at assessing the feasibility and outcomes of implementing systematic PMI screening. Hs-cTn concentrations were measured before and after surgery. PMI was defined as a postoperative hs-cTnT of ≥14 ng/L, exceeding the preoperative value by 50%. All patients were followed-up during the hospitalization, at one month and one year after surgery. The primary outcome was the incidence of death and major cardiovascular and cerebrovascular events (MACCE). The secondary outcomes focused on the individual components of MACCE. We included two-thirds of all eligible high-risk patients and achieved almost complete compliance with follow-ups. The prevalence of PMI was 15.7%, suggesting a higher presence of cardiovascular (CV) antecedents, increased perioperative CV complications, and higher preoperative hs-cTnT values. The all-cause death rate was 1.7% in the first month, increasing up to 11.2% at one year. The incidence of MACCE was 9.5% and 8.6% at the same time points. Given the observed elevated frequencies of PMI and MACCE, implementing systematic PMI screening is recommendable, particularly in patients with increased cardiovascular risk. However, it is important to acknowledge that achieving optimal screening implementation comes with various challenges and complexities.

Predictive accuracy of cardiac risk indices for cardiovascular complications in patients undergoing noncardiac surgery

Objective: To compare predictive accuracy of the American Society of Anesthesiologists (ASA) score and various cardiac risk indices for perioperative cardiovascular (CV) complications in patients undergoing noncardiac surgery.Materials and methods: We examined 243 patients (148 men and 95 women) aged 45 to 84 (66 [60-71] years) prior to their elective oncological and vascular surgery. We assessed patients using the ASA physical status classification system, Revised Cardiac Risk Index (RCRI), Gupta Myocardial Infarct or Cardiac Arrest (MICA) calculator, and Khoronenko cardiac risk index and analyzed perioperative CV complications.Results: We detected complications in 30 (12.3%) patients, with 3 (1.24%) of them having 2 concomitant CV complications. One death (0.41%) was registered. The MICA risk calculator had the highest predictive value (AUC ROC = 0.753). Risk scores over 0.95% discriminated patients with perioperative CV complications with sensitivity and specificity of 73.3% and 67.45%, respectively.Conclusions: We recommend using the MICA risk calculator to predict perioperative CV complications following elective oncological and vascular surgery.

Preoperative Right Ventricular Echocardiographic Parameters Predict Perioperative Cardiovascular Complications in Patients Undergoing High risk Non-Cardiac Surgery

Background: Every year, 200 million people worldwide have major non-cardiac surgery (NCS), and 10 million people experience a significant cardiac problem during the first 30 days following NCS. Perioperative cardiovascular complications (PCCs), are extremely significant since they contribute to at least one-third of perioperative mortality, lengthen hospital stays, and raise medical expenses.

A06] Sex Specific Differences in Pre-operative Standard of Care for Infrarenal AAA Repair and Association with Peri-operative Major Adverse Cardiovascular Events and Death

<h3>Objective</h3> Following elective infrarenal abdominal aortic aneurysm (IRAAA) repair, women have a higher rate of major adverse cardiovascular events and death (MACED). Disparity in pre-operative standard of care (SOC) may contribute. <h3>Methods</h3> Elective IRAAA repair data from the National Vascular Registry, 2013 – 2020 were analysed. SOC was defined for pre-operative assessment (multidisciplinary/anaesthetic review), waiting times, and cardiovascular risk prevention. Analyses and multivariable logistic regression were conducted according to a pre-specified plan. <h3>Results</h3> There were 21 810 patients (2 380 women; 19 430 men). Women were less often repaired within SOC waiting times (51.5% <i>vs</i>. 59.6%, <i>p</i> < .01), but received similar SOC pre-operative assessment (72.1% <i>vs</i>. 72.5%, <i>p</i> not significant). Women had ischaemic heart disease less often (29.0% <i>vs</i>. 37.7%, <i>p</i> < .01), but those with known cardiovascular co-morbidity received SOC risk prevention more often (52.1% <i>vs.</i> 47.3%, <i>p</i> < .01). Overall, women were less likely to receive antiplatelets (72.2% <i>vs</i>. 75.2%, <i>p</i> < .01) or statins (77.1% <i>vs</i>. 80.6%, <i>p</i> < .01). Women were at greater risk of MACED following open (12% <i>vs</i>. 8.9%, <i>p</i> < 0.01) and endovascular (4.9 % <i>vs.</i> 2.9%, <i>p</i> < .01) repair: overall odds ratio (OR) 1.51, adjusted for age and repair type; OR 1.28 following adjustment for demographics, co-morbidities and SOC. SOC waiting time was associated with a reduction in risk (OR 0.79) for both sexes. SOC pre-operative assessment reduced MACED risk for women (OR 0.80), but not men (OR 1.09). SOC cardiovascular risk prevention did not significantly influence MACED risk. <h3>Conclusion</h3> Treatment within SOC waiting time is independently associated with a reduction in MACED risk for both sexes, SOC pre-operative assessment is associated with risk reduction for women only.

Comparative Study of Cardiac Risk Indices to Predict Perioperative Cardiovascular Outcome in Patients with Peripheral Vascular Diseases

Introduction: Existing methodologies and risk stratification indices for predicting peri-operative cardiac complications in vascular surgery patient lack sufficient predictive value and therefore cannot be recommended for risk stratification. There are no Indian studies for preoperative cardiac risk scores for patients who undergo vascular and endovascular procedures. Therefore, an attempt was made to risk stratify and compare two existing cardiac risk indices (i.e., Detsky's modified cardiac risk index vs. Revised cardiac risk index [RCRI]) to predict peri-operative morbidity and mortality due to cardiac causes. The aim of this study: (a) To compare Detsky's modified cardiac risk index and RCRI to predict perioperative cardiovascular outcome in patients with peripheral vascular disease undergoing surgical intervention. (b) To predict perioperative cardiovascular outcome based on cardiac risk index in patients with peripheral vascular disease undergoing surgical intervention. Materials and Methods: This is an observational, prospective, longitudinal, controlled cohort study, which assessed 103 patients admitted at vascular centre for a period of 2 years. All patients undergoing vascular surgical procedure and evaluated by a cardiologist in the preoperative period were included in the study. Results: Eighteen patients (17.4%) had cardiac complications. The Detsky's index was found to be a satisfactory predictor of postoperative cardiac events (P &lt; 0.001) as compared to RCRI which had a P &lt; 0.003. There were a total of 10 mortalities (9.7%). Detsky's model and RCRI had positive predictive value (PPV) of 73.3% and 31.4%, specificity of 94.1% and 72.7%, respectively. Discussion: The overall sensitivity, specificity, PPV, negative predictive value of the Detsky's risk index, and RCRI in the prediction of cardiac events were 31.4%, 94.1%, 73.3%, 72.7% and 73.3%, 72.7%, 31.4%, 94.1%, respectively. In our study, the area under ROC for Detsky class was 0.76 versus 0.75 and superior to C statistic. However, the area under ROC for RCRI class was 0.72 versus 0.75 and inferior to C statistic. One important inference from the study was that 77.6% patients were smoker in the study group which emphasize the direct relation of peripheral vascular disease with smoking. Conclusion: The study concluded that patients with good surgical risk and profile undergoing minor vascular procedures can be operated without further testing. For other patients, the next step would be to incorporate the Detsky index. A Detsky score of 20 or more is comparable to a major clinical predictor in the American College of Cardiology/American Heart Association scheme.

Trends in cardiology follow-up and long-term care for patients who experienced cardiac events after surgery for gynecologic malignancies (490)

Objectives: Cardiovascular (CV) disease is a leading cause of mortality in older women, but there is limited data regarding women with gynecologic cancer. Oncologic diagnoses represent an independent elevated risk for CV events, and perioperative cardiac events are associated with a significantly higher risk of long-term CV disease. However, formal co-management or facilitated entry to care are limited between gynecologic oncology and cardiology. We aimed to characterize referral rates for cardiology care and follow-up for women with gynecologic malignancy who experienced perioperative or subsequent CV events. Methods: A retrospective cohort analysis was performed from January 1, 2013, to December 31, 2019, of all patients with gynecologic malignancies who had either a perioperative (within 30 days) or subsequent cardiac event. Events were abstracted from the electronic medical record using ICD codes. Demographic, medical history, comorbid conditions, oncologic course, and event-based data were analyzed using SAS 9.4. Results: One hundred seventy-four patients met the inclusion criteria; 76 (45.3%) had ovarian cancer, 69 (40.0%) had uterine cancer, and 23 (13.7%) had cervical/vulvovaginal cancer. The average age was 67.4 years, 63.0% were White, 35.3% were Black, and 1.2% were Asian. Fifty-four patients had a perioperative CV event. Of these patients, 63.8% were recommended for cardiology referral, and 70.3% had documented follow-up. Total 46.7% of patients received a new chronic CV diagnosis via this pathway. During the follow-up period, 52 patients had a CV event. Of these, 60.5% were recommended for cardiology referral, and 86.3% had documented follow-up. Almost 54.1% received a new chronic CV diagnosis. Of patients who had a perioperative CV event but were not recommended for cardiology follow-up, 29.4% had a subsequent CV event. Conclusions: As the survivorship of women with gynecologic malignancies improves, the interactions between oncologic care and CV health represent an opportunity to improve collaboration. Approximately half of the patients with perioperative or followup CV events were diagnosed with an underlying CV condition. Approximately one-third of patients who did not receive follow-up at the first event experienced a second event. Establishing a pathway for care may decrease the rate of these events and prevent morbidity. Furthermore, increasing evidence suggests that these events impact oncologic outcomes and overall mortality. Objectives: Cardiovascular (CV) disease is a leading cause of mortality in older women, but there is limited data regarding women with gynecologic cancer. Oncologic diagnoses represent an independent elevated risk for CV events, and perioperative cardiac events are associated with a significantly higher risk of long-term CV disease. However, formal co-management or facilitated entry to care are limited between gynecologic oncology and cardiology. We aimed to characterize referral rates for cardiology care and follow-up for women with gynecologic malignancy who experienced perioperative or subsequent CV events. Methods: A retrospective cohort analysis was performed from January 1, 2013, to December 31, 2019, of all patients with gynecologic malignancies who had either a perioperative (within 30 days) or subsequent cardiac event. Events were abstracted from the electronic medical record using ICD codes. Demographic, medical history, comorbid conditions, oncologic course, and event-based data were analyzed using SAS 9.4. Results: One hundred seventy-four patients met the inclusion criteria; 76 (45.3%) had ovarian cancer, 69 (40.0%) had uterine cancer, and 23 (13.7%) had cervical/vulvovaginal cancer. The average age was 67.4 years, 63.0% were White, 35.3% were Black, and 1.2% were Asian. Fifty-four patients had a perioperative CV event. Of these patients, 63.8% were recommended for cardiology referral, and 70.3% had documented follow-up. Total 46.7% of patients received a new chronic CV diagnosis via this pathway. During the follow-up period, 52 patients had a CV event. Of these, 60.5% were recommended for cardiology referral, and 86.3% had documented follow-up. Almost 54.1% received a new chronic CV diagnosis. Of patients who had a perioperative CV event but were not recommended for cardiology follow-up, 29.4% had a subsequent CV event. Conclusions: As the survivorship of women with gynecologic malignancies improves, the interactions between oncologic care and CV health represent an opportunity to improve collaboration. Approximately half of the patients with perioperative or followup CV events were diagnosed with an underlying CV condition. Approximately one-third of patients who did not receive follow-up at the first event experienced a second event. Establishing a pathway for care may decrease the rate of these events and prevent morbidity. Furthermore, increasing evidence suggests that these events impact oncologic outcomes and overall mortality.

Peri-operative cardiac events in patient undergoing surgery for gynecologic malignancies are associated with long-term cardiovascular outcomes (489)

Objectives: Cardiovascular (CV) disease is a leading cause of mortality in older women, but there is limited data on women with gynecologic cancer. Cancer and CV disease have significant pathophysiologic overlap, and both independently increase the risk of the other. Cancer patients have a 5-fold increased risk of major stroke or myocardial infarction, and patients who have perioperative cardiac events in noncardiac surgeries have significantly increased mortality. We aimed to characterize the incidence of perioperative events and long-term outcomes in women undergoing surgery for gynecologic malignancy. Methods: A retrospective cohort analysis was performed from January 1, 2013, to December 31, 2019, of all patients with gynecologic malignancies who had either a perioperative (within 30 days of surgery) or subsequent cardiac event. Events were abstracted from the electronic medical record using ICD codes. Demographic, medical history, comorbid conditions, oncologic course, and event-based data were analyzed using SAS 9.4. Results: One hundred seventy-four patients met the inclusion criteria; 76 (45.3%) had ovarian cancer, 69 (40.0%) had uterine cancer, and 23 (13.7%) had cervical/vulvovaginal cancer. The average age was 67.4 years, 63.0% were white, 35.3% were Black, and 1.2% were Asian. Fifty-four (31.0%) patients experienced a perioperative CV event. Arrhythmia was most common (23.6%), followed by heart failure exacerbation (4.6%) and NSTEMI (4.6%). Of these patients, 35.2% had not been identified to be at increased cardiac risk preoperatively. Among the patients who had a perioperative event, 46.7% were diagnosed with a new chronic CV condition. After 30 days of follow-up, 45.4% of patients had a new CV event: arrhythmia was most common (17.8%), followed by heart failure exacerbation (16.7%) and stroke/ TIA (5.2%). Of these patients, 33 were diagnosed with at least one chronic CV condition, including heart failure (51.5%), atrial fibrillation (30.3%), CAD (6.1%), and pulmonary hypertension (6.1%). Fifteen patients who had perioperative events had a subsequent CV event. Conclusions: Perioperative cardiac events related to surgery for gynecologic malignancy, though rare, may represent a sentinel event for CV health and represent an opportunity for early intervention. Almost half of the patients with a CV event were diagnosed with a new chronic CV condition, and almost one-third had a subsequent CV event. Additional studies should focus on the long-term sequelae of perioperative CV events in gynecologic oncology patients and their interaction with oncologic outcomes. Objectives: Cardiovascular (CV) disease is a leading cause of mortality in older women, but there is limited data on women with gynecologic cancer. Cancer and CV disease have significant pathophysiologic overlap, and both independently increase the risk of the other. Cancer patients have a 5-fold increased risk of major stroke or myocardial infarction, and patients who have perioperative cardiac events in noncardiac surgeries have significantly increased mortality. We aimed to characterize the incidence of perioperative events and long-term outcomes in women undergoing surgery for gynecologic malignancy. Methods: A retrospective cohort analysis was performed from January 1, 2013, to December 31, 2019, of all patients with gynecologic malignancies who had either a perioperative (within 30 days of surgery) or subsequent cardiac event. Events were abstracted from the electronic medical record using ICD codes. Demographic, medical history, comorbid conditions, oncologic course, and event-based data were analyzed using SAS 9.4. Results: One hundred seventy-four patients met the inclusion criteria; 76 (45.3%) had ovarian cancer, 69 (40.0%) had uterine cancer, and 23 (13.7%) had cervical/vulvovaginal cancer. The average age was 67.4 years, 63.0% were white, 35.3% were Black, and 1.2% were Asian. Fifty-four (31.0%) patients experienced a perioperative CV event. Arrhythmia was most common (23.6%), followed by heart failure exacerbation (4.6%) and NSTEMI (4.6%). Of these patients, 35.2% had not been identified to be at increased cardiac risk preoperatively. Among the patients who had a perioperative event, 46.7% were diagnosed with a new chronic CV condition. After 30 days of follow-up, 45.4% of patients had a new CV event: arrhythmia was most common (17.8%), followed by heart failure exacerbation (16.7%) and stroke/ TIA (5.2%). Of these patients, 33 were diagnosed with at least one chronic CV condition, including heart failure (51.5%), atrial fibrillation (30.3%), CAD (6.1%), and pulmonary hypertension (6.1%). Fifteen patients who had perioperative events had a subsequent CV event. Conclusions: Perioperative cardiac events related to surgery for gynecologic malignancy, though rare, may represent a sentinel event for CV health and represent an opportunity for early intervention. Almost half of the patients with a CV event were diagnosed with a new chronic CV condition, and almost one-third had a subsequent CV event. Additional studies should focus on the long-term sequelae of perioperative CV events in gynecologic oncology patients and their interaction with oncologic outcomes.

Nongated Computed Tomography Predicts Perioperative Cardiovascular Risk in Lung Cancer Surgery

BackgroundThe coronary artery calcification score (CACS), a strong predictor of cardiovascular events and mortality, can be assessed by nongated chest computed tomography (CT). The study aimed to determine whether CACS based on nongated CT is predictive of perioperative cardiovascular events during intermediate-risk lung cancer surgery. MethodsIn this retrospective, single-center study, we used nongated CT images to evaluate CACS in 4491 patients with lung cancer who underwent intermediate-risk surgeries. Perioperative cardiovascular events were defined as in-hospital cardiac death, nonfatal myocardial infarction, heart failure, atrial and ventricular arrhythmia with hemodynamic compromise, and complete heart block. Risk factors of perioperative cardiovascular events were identified by multivariate logistic regression analysis. ResultsIn total, 110 inpatients (2.5%) experienced perioperative cardiac events. Coronary calcification was observed on nongated CT in 1070 (23.8%) patients. CACS was significantly associated with the incidence of cardiovascular events and longer hospital stays. According to receiver operating characteristic curve analysis, the CACS cutoff value was set to 1. In the multivariate analysis, CACS ≥1 (odds ratio, 1.75; 95% CI, 1.14-2.68; P = .011) or the number of calcified vessels (odds ratio, 1.23; 95% CI, 1.01-1.50; P = .043), age, forced expiratory volume in 1 second/predicted, operation time, and thoracotomy were predictive of cardiovascular complications. ConclusionsCACS is an independent predictor of severe perioperative cardiovascular risk in patients undergoing intermediate-risk lung cancer surgery. CACS may represent a valuable tool for preoperative risk assessment of these patients.

Incidence and Risk Factors for Perioperative Cardiovascular Complications in Spine Surgery.

Background:An increasing number of patients are opting for spine surgery despite the associated risk of cardiovascular complications. The evidence regarding the incidence and risk factors of cardiovascular complications in spine surgery is insufficient. Therefore, we aimed to determine the incidence and risk factors for cardiovascular complications that occur perioperatively in spine surgery. Methods:This retrospective study included all patients who underwent spine surgery between January 2018 and December 2019 at a single center. Demographic, clinical, and operative data were collected from electronic medical records. The incidence of perioperative cardiac complications was determined. Univariate and multivariate analyses were performed to identify risk factors for the development of perioperative cardiovascular complications in the participants. Results:Of the 1,002 eligible patients enrolled in the study, six developed cardiac complications. Acute myocardial infarction, cardiac arrest, and congestive heart failure occurred in one, two, and three patients, respectively. Risk factors for cardiovascular complications included scoliosis surgery (odds ratios (OR): 18.61; 95% confidence interval (CI): 1.346-257.35) and a history of congestive heart failure (OR: 120.97; 95% CI: 2.12-6898.80). Conclusion:The incidence of perioperative cardiovascular complications in patients who underwent spine surgery was 0.6%. High-risk patients should be closely monitored optimally managed throughout the perioperative period.

Relation of Previous Coronary Artery Bypass Grafting and/or Percutaneous Coronary Intervention to Perioperative Cardiovascular Outcomes in Patients Who Underwent Noncardiac Surgery

Patients with ischemic heart disease frequently undergo noncardiac surgery. We examined perioperative surgical outcomes in patients with and without previous coronary revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Adults ≥45 years old who underwent noncardiac surgery between 2010 and 2014 were identified from the National Inpatient Sample. Previous CABG and PCI were identified using International Classification of Diseases, Ninth Revision codes. Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as the composite of in-hospital mortality, acute myocardial infarction, and acute ischemic stroke. Multivariable logistic regression models were used to estimate associations between previous coronary revascularization and surgical outcomes after adjustment for clinical covariates. We identified 25,091,140 hospitalizations for noncardiac surgery, of which 8.4% had a history of coronary revascularization (47% previous CABG without PCI, 45% previous PCI without CABG, and 8% previous CABG and PCI). Hospitalized patients with versus without previous coronary revascularization had a higher crude incidence (4.0% vs 2.6%, p<0.001) but lower odds of MACCE (adjusted odds ratio 0.96, 95% CI 0.94 to 0.98) driven by a lower risk of death and ischemic stroke. When analyzed by revascularization strategy, lower odds of MACCE were restricted to patients with previous CABG, driven by excess perioperative acute myocardial infarction risks after PCI. In patients with established cardiovascular disease, previous coronary revascularization was associated with lower odds of MACCE (adjusted odds ratio 0.76, 95% CI 0.75 to 0.78), regardless of revascularization strategy. In conclusion, previous coronary revascularization is associated with lower odds of MACCE after noncardiac surgery, but perioperative risks vary by mode of coronary revascularization.

Update of the Brazilian Society of Cardiology's Perioperative Cardiovascular Assessment Guideline: Focus on Managing Patients with Percutaneous Coronary Intervention - 2022.

1. Introdução O cuidado de pacientes submetidos à intervenção coronária percutânea (ICP) e à eventual necessidade de cirurgia não cardíaca precoce é um dos tópicos que gera mais debate em medicina perioperatória, pois envolve questões importantes sobre o manejo da terapia antitrombótica, além das questões habituais de manejo do risco cardíaco em coronariopatia. Se, por um lado, é necessário lidar com o risco hemorrágico, inerente à cirurgia e potencializado pelos antiagregantes plaquetários, por outro, é fundamental considerar o aumento do [...]