Relationship between preoperative abnormal echocardiography and occurrence of postoperative major adverse cardiac events in non-cardiac surgery patients: A nested case-control study / 解放军医学杂志

ABSTRACT

Objective To investigate the relationship between preoperative abnormal transthoracic echocardiogram (TTE) and postoperative major adverse cardiac events (MACE) in patients undergoing non-cardiac surgery.Methods This study was a nested case control study.Patients who underwent elective non-cardiac surgery in Peking University First Hospital from November 15,2012 to January 15,2013 were enrolled.We screened patients who received preoperative TTE examination from electrical medical record.The primary outcome of this study was the incidence of postoperative MACEs.The patients were divided into MACE group and control group depending on if they suffered MACE.For each patient in MACE group,4 patients without MACE events were selected for control group in term of two criteriasame revised cardiac risk index and same type of surgery.Related perioperative data were collected.Multivariate logistic analysis was used for screening potential risk factors related to MACE.Results During the study period,a total of 2975 patients undergoing elective surgery,2081 met the inclusion criteria.Amongst these patients,530 patients received preoperative TTE examinations and 25 suffered postoperative MACEs.Overall incidence of TTE abnormalities was 91.9％(487/530).25 patients with MACE and 100 patients without MACE (as control group) were selected for case control analysis.The incidence of TTE abnormality was about 92.0％ (23/25) in MACE group and 93.0％(93/100) in control group (OR=0.866,95％CI 0.169-4.446,P=1.000).Multivariate logistic analysis showed that left ventricular hypertrophy was an independent risk of MACE (OR=4.324,95％CI 1.320-14.160,P=0.016),female(OR=4.782,95％CI 1.636-13.980,P=0.005) and history of chronic renal failure (OR=21.952,95％CI 1.547-311.475,P=0.016) were also related with MACE.The predictive value of preoperative TTE abnormality against MACE was very low in ROC analysis (AUC=0.501,P=0.992).Conclusions Left ventricular hypertrophy is related to increased risk of postoperative MACE.However,further studies are needed to confirm the value of TTE examination as a routine examination for cardiac evaluation before surgery.