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JACC March 20, 2018

Volume 71, Issue 11

Prevention
ASSOCIATIONS BETWEEN CONVENTIONAL CARDIOVASCULAR RISK FACTORS AND RISK OF
PERIOPERATIVE ACUTE MYOCARDIAL INFARCTION AFTER NON-CARDIAC SURGERY
Poster Contributions
Poster Hall, Hall A/B
Sunday, March 11, 2018, 3:45 p.m.-4:30 p.m.

Session Title: Risk Factor Assessment and Risk Prediction to Guide ASCVD Prevention
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1260-414

Authors: Tanya Wilcox, Nathaniel Smilowitz, Jonathan Newman, Jeffrey Berger, New York University School of Medicine, New York, NY,
USA
Background: Adverse cardiovascular (CV) events are a leading cause of morbidity and mortality after non-cardiac surgery. Prior studies
report associations between individual CV risk factors (RF) and the risk of acute myocardial infarction (AMI), but the combined effects of
these RFs are largely unknown.
Methods: Data from patients undergoing major non-cardiac surgery 2009-2015 were identified from the United States National Surgical
Quality Improvement Program. Age, sex and race/ethnicity adjusted logistic regression was used to estimate the impact of 3 CV RFs (e.g.
diabetes mellitus, hypertension and current smoking) on odds of AMI within 30-days postoperatively.
Results: The study sample consisted of 3,872,589 surgical cases. Mean age was 57, 57% were female and 75% were white. A majority
(59%) had more than 1 RF. The incidence of AMI increased in a stepwise fashion (0.10% for 0 RFs, 0.41% for 1 RF, 0.81% for 2 RFs, and
1.1% for 3 RFs). The multivariable-adjusted odds ratios for 1, 2 and 3 CV RFs were 2.23 (95% CI 2.06-2.32), 4.40 (95% 4.08-4.61), and
7.50 (95% 6.86-8.21), respectively. This trend was consistent in females and males (figure).
Conclusion: Patients with multiple CV RFs are at increased risk of postoperative AMI, while patients without CV RFs are at minimal
risk. Further research is necessary to determine whether optimization of CV RFs with lifestyle and medical therapy may decrease CV
complications after non-cardiac surgery.

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