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 Enrolling surgical departments: N = 1211 (all pts. with CV disease undergoing General surgery (43,3% pts) major non-cardiac surgery during the study period Trauma / orthopedic surgery (39,9%) 2011–13 (6,3% of 18 951 surgical pts) Urology (10,5%) General anesthesia in 64,4% Neurosurgery (5,5%) Anesthesiology (0,8%) 1% Study design, coordination, data analysis: Cardiology 37% elective acute not specified 62%
In-hospital mortality of patients with a cardiovascular disease (n=1200) vs. those without CVD (n=17740) 4,5 3,9 4 3,5 3 2,5 CVD+ 2 CVD- 1,5 0,9 1 0,5 0 In-hospital mortality
Duration of ASA interruption in subgroups per complication type ASA 29 27 p<0.001 Median 25 25%-75% Non-Outlier Range 23 p=0.027 21 19 Days without ASA n.s. 17 15 13 11 9 7 5 3 1 -1 No complications Cardiovascular Bleeding Both Complications
ASA interruption [days] vs. complication risk [%] 14 12 10 8 Risk of CV complications [%] 6 Risk of bleeding complications [%] 4 2 0 ASA interruption 0-2 ASA interruption 0-4 ASA interuption 0-6 ASA interruption ≥7 days days days days
Risk factors for complications (multivariant analysis) Bleeding complications Cardiovascular complications Perioperative ischemia - multivariate-adjusted estimates of odds ratios General anesthesia Acute operation Chronic heart failure IHD, stp PCI Hemoglobine Age continuous in years 0 1 2 3 4 5 6 7 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.
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