Multidisciplinary Insights into Perioperative Cardiac Events in Non-Cardiac Surgery: an ECG Holter Monitoring Study.

Abstract

Background: Cardiovascular complications after non-cardiac surgery have a major impact on perioperative morbidity and mortality. Despite several scales and scores for assessing the preoperative cardiovascular status, an individualized assessment focused on each patient is mandatory.

Aim: To identify the new cardiac events that occur after non-cardiac surgery.

Methods: In 100 patients hospitalized in the general surgery department with acute and chronic surgical pathologies, the perioperative cardiac events were assessed using Holter monitoring along with clinical and biochemical markers, including C reactive protein (CRP) and high-sensitive troponin (hscTnI).

Results: Out of the 100 participants with a mean age of 54.5 (43-77.9) years, 54% were men. Ten patients developed paroxysmal postoperative atrial fibrillation (AF), which was related with longer surgery time 165 (150-180) vs 120 (90-150) minutes (p=0.002) and postoperative anaemia [haemoglobin (Hg) 10.4 (9.37-12.6) vs 12.1 (11-13.2) g/dL, (p=0.041)]. Higher CRP levels were also correlated with paroxysmal AF. The AF group correlated with higher values of presurgical CRP: 81 (46.5-186.75) vs 27 (6-102.5) mg/dL, (p=0.041). Higher postsurgical CRP values were also found in the AF group: 76 (47.75-110.75) vs 40.5 (12-82.5) mg/dL (p=0.045). Sinus pauses were present in nine patients and there was a strong association between sinus pauses and age (p = 0.011), history of high blood pressure (HBP) (p = 0.031), intraoperative HBP (p = 0.026) and the preexisting AF (p = 0.028). Postsurgical ST changes were present in 30 patients and ST depression was correlated with age (p < 0.001), prolonged surgery time [150 (120-180) vs 120 (90-150) minutes (p < 0.001)], history of HBP [(33.3% vs 12.2%) (p=0.017)] and intraoperative maximum values of BP (p = 0.007).

Conclusions: There is an increased risk of cardiovascular events during the postoperative period of non-cardiac surgery in patients with advanced age, pre-existing diseases (hypertension, preexisting atrial fibrillation, diabetes mellitus), the level of inflammation and longer intraoperative stress. Holter monitoring revealed rhythm and conduction disorders as well as ST segment changes that were associated with the inflammatory status and slightly elevated cardiac enzyme levels. Future studies are needed to see the impact of cardiac complications in the long term.