PRAGUE-14 Perioperative cardiovascular complications versus - - PowerPoint PPT Presentation

PRAGUE-14 Perioperative cardiovascular complications versus perioperative bleeding in patients with cardiovascular disease undergoing non-cardiac surgery.

Petr Widimský, Zuzana Moťovská Lukáš Havlůj, Martina Ondráková, Radek Bartoška, Lukáš Bittner, *Ladislav Dušek, Valér Džupa, Jiří Knot, Martin Krbec, Libor Mencl, Jan Pachl, Robert Grill, Pavel Haninec, Petr Waldauf, Robert Gürlich University Hospital Kralovske Vinohrady Prague, CZ

Patients, type of surgery

62% 37% 1% elective acute not specified N = 1211 (all pts. with CV disease undergoing major non-cardiac surgery during the study period 2011–13 (6,3% of 18 951 surgical pts) General anesthesia in 64,4% Enrolling surgical departments: General surgery (43,3% pts) Trauma / orthopedic surgery (39,9%) Urology (10,5%) Neurosurgery (5,5%) Anesthesiology (0,8%) Study design, coordination, data analysis: Cardiology

In-hospital mortality of patients with a cardiovascular disease (n=1200) vs. those without CVD (n=17740)

3,9 0,9 0,5 1 1,5 2 2,5 3 3,5 4 4,5 In-hospital mortality CVD+ CVD-

Duration of ASA interruption in subgroups per complication type

ASA

No complications Cardiovascular Bleeding Both

Complications

• 1

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29

Days without ASA

Median 25%-75% Non-Outlier Range

n.s. p<0.001 p=0.027

ASA interruption [days] vs. complication risk [%]

2 4 6 8 10 12 14

ASA interruption 0-2 days ASA interruption 0-4 days ASA interuption 0-6 days ASA interruption ≥7 days

Risk of CV complications [%] Risk of bleeding complications [%]

Risk factors for complications (multivariant analysis)

Cardiovascular complications Bleeding complications

Perioperative ischemia - multivariate-adjusted estimates of odds ratios

1 2 3 4 5 6 7 Age continuous in years Hemoglobine IHD, stp PCI Chronic heart failure Acute operation General anesthesia

OR, 95%CI

How to interpret data on ASA interruption ?

• Patients with no (or only short) ASA interruption before

surgery had more bleeding complications as well as more cardiovascular complications then those in whom ASA was stopped at least one week before surgery.

• However, multivariate statistical analysis did not found

this to be an INDEPENDENT factor.

• Most likely this is related to the fact, that short ASA

interruption was mostly among patients undergoing acute surgery (with inherent higher risk)

• A more detailed analysis focused on a subgroup of

elective surgical patients is planned

Conclusion

• Perioperative cardiovascular complications in

non-selected pts with cardiovascular diseases who undergo non-cardiac surgery are rare.

• Antithrombotic therapy interruption shortly

before surgery was not associated with lower risk of perioperative cardiovascular complications in the overall population

• Among elective surgical patients there was a

trend towards increased risk of complications when ASA was stopped 4-8 days prior to surgery.