Report on preoperative assessment of perioperative cardiovascular adverse events in elderly patients undergoing noncardiac surgery
10.3969/j.issn.1008-9691.2024.06.011
- VernacularTitle:老年患者非心脏手术围术期心血管不良事件术前评估报告
- Author:
Jin DU
1
;
Tongxin CHEN
;
Yudi DU
;
Keliang XIE
Author Information
1. 天津医科大学总医院麻醉科,天津 300052
- Publication Type:Journal Article
- Keywords:
Non-cardiac surgery;
Perioperative cardiovascular adverse events;
Preoperative assessment
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2024;31(6):702-707
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore indicators of risks for preoperative adverse cardiovascular events(PACE)in elderly patients who underwent non-cardiac surgery(NCS).Methods The clinical data of elderly patients who had undergone NCS at Tianjin Medical University General Hospital from January 2022 to March 2024 were analyzed retrospectively,including gender,age,medical history,operation ways,and preoperative creatinine(Cr),hypersensitive C-reactive protein(hs-CRP),hypersensitivity cTnT(hs-cTnT),MB isoenzyme of creatine kinase(CK-MB),N-terminal pro-brain natriuretic peptide(NT-proBNP)and D-Dimer,prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib).To measure the revised cardiac risk index(RCRI),the 30-day prognosis of the patients was followed up.Patients were divided into PACE group and non-PACE group according to the occurrence of PACE,and the clinical data between the two groups were compared.Multiple Logistics regression was used to identify independent risk factors for PACE,and the receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each risk factor for PACE risk in elderly patients underwent NCS.Results A total of 112 elderly patients underwent NCS were enrolled,including 9 cases in the PACE group(incidence rate 8.03%)and 103 cases in the non-PACE group.Patients'age(years old:75.1±6.4 vs.69.4±7.2,P=0.002),preoperative incidence of coronary heart disease[44.4%(4/9)vs.28.2%(29/103),P=0.004],incidence of heart failure[22.2%(2/9)vs.6.8%(7/103),P=0.003],NT-proBNP[(ng/L):485.17(196.10,787.53)vs.98.41(73.81,160.35),P=0.001],hs-cTnT[(μg/L):0.043(0.023,0.087)vs.0.005(0.003,0.008),P=0.002],and D-Dimer[(μg/L):2 953(2 674,3 570)vs.514(260,1 010),P=0.001]levels in the PACE group were significantly higher than those in the non-PACE group,the proportion of RCRI 2-3 scores in PACE group were significantly higher than those in non-PACE group[2 scores:44.4%(4/9)vs.18.4%(19/103),3 scores:33.3%(3/9)vs.14.6%(15/103),P=0.047].As shown in multiple Logistic regression analysis,age,preoperative NT-proBNP levels and RCRI scores≥2 were independent risk factors affecting the prognosis for PACE occurrence[odds ratio(OR)and 95%confidence interval(95%CI)were 1.163(1.032-1.310),1.021(1.008-1.031)and 1.261(1.003-1.585),P values were 0.013,0.001,0.048,respectively].As shown in ROC curve analysis,age,NT-proBNP and RCRI had predictive value for the occurrence of PACE in NCS patients,the area under the curve(AUC)and 95%CI of age,NT-proBNP and RCRI were 0.795(0.675-0.915),0.908(0.838-0.979)and 0.735(0.556-0.912),with P=0.030,<0.001 and 0.020 respectively.The optimal cut-off values were:age≥69.5 years(sensitivity was 88.9%,specificity was 56.3%);NT-proBNP≥177.0 ng/L(sensitivity was 88.9%,specificity was 83.5%);RCRI≥1.5 points(sensitivity was 77.8%,specificity was 67.0%).Conclusions Age,NT-proBNP levels and RCRI have certain predictive values for the occurrence of PACE in NCS patients undergoing NCS,advanced age,higher NT-proBNP levels,and elevated RCRI scores were associated with increased PACE risk in elderly patients undergoing NCS.While age showed high sensitivity but limited specificity,combining NT-proBNP(with high diagnostic accuracy)and RCRI(with objective scoring)improved preoperative PACE risk prediction.
