MACE Up for High-Risk Patients After Noncardiac Surgery

FRIDAY, Oct. 16, 2020 — About 20 percent of high-risk patients undergoing noncardiac surgery will develop one or more major adverse cardiovascular events (MACE) within one year, according to a study published online Oct. 15 in the European Heart Journal: Acute Cardiovascular Care.

Lorraine Sazgary, M.D., from the University Basel in Switzerland, and colleagues conducted a prospective observational study implementing perioperative screening for postoperative MACE in patients at increased cardiovascular risk (≥65 years or ≥45 years with history of cardiovascular disease) undergoing noncardiac surgery. To detect asymptomatic MACE, all patients received serial measurements of cardiac troponin.

The researchers found that the incidence of MACE was 15.2 percent among 2,265 patients within 30 days and 20.6 percent within 365 days. Within 30 and 365 days, cardiovascular death occurred in 1.2 and 3.7 percent, respectively; hemodynamically relevant arrhythmias occurred in 1.2 and 2.1 percent; acute heart failure in 1.6 and 4.2 percent; spontaneous myocardial infarction in 0.5 and 1.6 percent; and perioperative myocardial infarction in 13.2 and 14.8 percent. Until day 135, the incidence of MACE was increased above the presumed baseline rate.

“The risk for MACE remains increased for about five months after noncardiac surgery,” the authors write. “As this incidence is much higher than commonly expected, novel strategies to reduce cardiac complications seem warranted.”

Several authors disclosed ties to the pharmaceutical industry.

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