Background: Perioperative hypotension is associated with cardiovascular events in patients having noncardiac surgery. It is unknown if the severity of preexisting coronary artery disease determines susceptibility to the cardiovascular risks of perioperative hypotension.
Methods: In this retrospective exploratory analysis of a substudy of an international prospective blinded cohort study, 955 patients 45 yr of age or older with history or risk factors for coronary artery disease underwent coronary computed tomographic angiography before elective inpatient noncardiac surgery. The authors evaluated the potential interaction between angiographic findings and perioperative hypotension (defined as systolic blood pressure less than 90 mmHg for a total of 10 min or more during surgery or for any duration after surgery and for which intervention was initiated) on the composite outcome of time to myocardial infarction or cardiovascular death up to 30 days after surgery. Angiography assessors were blinded to study outcomes; patients, treating clinicians, and outcome assessors were blinded to angiography findings.
Results: Cardiovascular events (myocardial infarction or cardiovascular death within 30 days after surgery) occurred in 7.7% of patients (74/955), including in 2.7% (8/293) without obstructive coronary disease or hypotension compared to 6.7% (21/314) with obstructive coronary disease but no hypotension (hazard ratio, 2.51; 95% CI, 1.11 to 5.66; P = 0.027), 8.8% (14/159) in patients with hypotension but without obstructive coronary disease (hazard ratio, 3.85; 95% CI, 1.62 to 9.19; P = 0.002), and 16.4% (31/189) with obstructive coronary disease and hypotension (hazard ratio, 7.34; 95% CI, 3.37 to 15.96; P < 0.001). Hypotension was independently associated with cardiovascular events (hazard ratio, 3.17; 95% CI, 1.99 to 5.06; P < 0.001). This association remained in patients without obstructive disease and did not differ significantly across degrees of coronary disease (P value for interaction, 0.599).
Conclusions: In patients having noncardiac surgery, perioperative hypotension was associated with cardiovascular events regardless of the degree of coronary artery disease on preoperative coronary computed tomographic angiography.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/ALN.0000000000002654 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Risk analysis of cardiovascular toxicity in patients with lymphoma treated with CD19 CAR T cells.
J Transl Med
January 2025
Department of Hematology Oncology, Affiliated Hospital of Guizhou Medical University, No. 4 Bei Jing Road, Yunyan District, Guiyang, 550004, Guizhou, China.
Background: Anti-CD19 chimeric antigen receptor (CAR) T cell therapy is a common, yet highly efficient, cellular immunotherapy for lymphoma. However, many recent studies have reported on its cardiovascular (CV) toxicity. This study analyzes the cardiotoxicity of CD19 CAR T cell therapy in the treatment of lymphoma for providing a more valuable reference for clinicians.
View Article and Find Full Text PDFLarge floods drive changes in cause-specific mortality in the United States.
Nat Med
January 2025
Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA.
Flooding greatly endangers public health and is an urgent concern as rapid population growth in flood-prone regions and more extreme weather events will increase the number of people at risk. However, an exhaustive analysis of mortality following floods has not been conducted. Here we used 35.
View Article and Find Full Text PDFEarly noninvasive ventilation in general wards for acute respiratory failure: an international, multicentre, open-label, randomised trial.
Br J Anaesth
January 2025
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
Background: The impact of noninvasive ventilation (NIV) managed outside the intensive care unit in patients with early acute respiratory failure remains unclear. We aimed to determine whether adding early NIV prevents the progression to severe respiratory failure.
Methods: In this multinational, randomised, open-label controlled trial, adults with mild acute respiratory failure (arterial oxygen partial pressure/fraction of inspiratory oxygen [Pao/FiO] ratio ≥200) were enrolled across 11 hospitals in Italy, Greece, and Kazakhstan.
Preoperative estimated glomerular filtration rate to predict cardiac events in major noncardiac surgery: a secondary analysis of two large international studies.
Br J Anaesth
January 2025
Population Health Research Institute, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada.
Background: Optimised use of kidney function information might improve cardiac risk prediction in noncardiac surgery.
Methods: In 35,815 patients from the VISION cohort study and 9219 patients from the POISE-2 trial who were ≥45 yr old and underwent nonurgent inpatient noncardiac surgery, we examined (by age and sex) the association between continuous nonlinear preoperative estimated glomerular filtration rate (eGFR) and the composite of myocardial injury after noncardiac surgery, nonfatal cardiac arrest, or death owing to a cardiac cause within 30 days after surgery. We estimated contributions of predictive information, C-statistic, and net benefit from eGFR and other common patient and surgical characteristics to large multivariable models.
Efficiency of fixed-dose combinations of statin and ezetimibe in the treatment of hypercholesterolemia.
Clin Investig Arterioscler
January 2025
Unidad de Cardiología, Hospital Universitario de Jaén, Jaén, España.
Objective: To estimate the clinical and economic benefits derived from increasing the use of fixed-dose combinations of high-intensity statins and ezetimibe in patients at high/very high cardiovascular risk, from the perspective of the Spanish National Health System (SNS).
Methods: A baseline scenario (current market shares) was compared with scenarios that increased the use of fixed-dose combinations (alternative: 30% increase; optimized: 69% increase). The potential annual increase in the number of controlled patients, cardiovascular events avoided and the associated savings in direct medical costs were estimated, including the cost of pharmacological treatment, follow-up, and managing cardiovascular events over a three-year time horizon.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!