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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.23043    [Epub ahead of print]
Published online May 10, 2023.
Perioperative adverse cardiac events and mortality after non-cardiac surgery: a multicenter study
Byungjin Choi1  , Ah Ran Oh2,3  , Jungchan Park1,2  , Jong-Hwan Lee2  , Kwangmo Yang1,4  , Dong Yun Lee1  , Sang Youl Rhee5  , Sang-Soo Kang6  , Seung Do Lee7  , Sun Hack Lee8  , Chang Won Jeong9  , Bumhee Park1,10  , Soobeen Seol1  , Rae Woong Park1  , Seunghwa Lee11 
1Department of Biomedical Sciences, Ajou University Graduate School of Medicine, Suwon, Korea
2Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
3Department of Anesthesiology and Pain Medicine, Kangwon National University Hospital, Chuncheon, Korea
4Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
5Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine. Seoul, 02447, Korea
6Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, 150 Seongan-ro, Gangdong-gu, Seoul 05355, South Korea
7Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, South Korea
8Division of Cardiology, Department of Internal Medicine, Pusan National University Hospital
9Central Research Center of Biomedical Research Institute, Wonkwang University Hospital
10Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for innovative medicine, Ajou University Medical Center, Suwon, Republic of Korea
11Wiltse Memorial Hospital, Suwon, Korea
Corresponding author:  Jungchan Park, Tel: +82-2-3410-3214, Fax: +82-2-3410-2849, 
Email: jc83.park@samsung.com
Seunghwa Lee, Tel: +82-2-3410-3214, Fax: +82-2-3410-2849, 
Email: shua9999@gmail.com
Received: 16 January 2023   • Revised: 9 May 2023   • Accepted: 10 May 2023
*Byungjin Choi and Ah Ran Oh contributed equally to this study as co-first authors.
Perioperative adverse cardiac events (PACE), a composite of myocardial infarction, coronary revascularization, congestive heart failure, arrhythmic attack, acute pulmonary embolism, cardiac arrest, and stroke during the 30-day postoperative period, is associated with long-term mortality, but with limited clinical evidence. We compared long-term mortality with PACE in nationwide multicenter electronic health records.
Data from seven hospitals converted to the Observational Medical Outcomes Partnership Common Data Model were used. We extracted the records of 277,787 adult patients over 18 years of age who underwent non-cardiac surgery for the first time at the hospital and had medical records for more than 180 days before surgery. We performed propensity score matching (PSM) and then an aggregated meta‑analysis.
After 1:4 PSM, 7,970 patients with PACE and 28,807 patients without PACE were matched. The meta‑analysis showed that PACE was associated with higher one-year mortality risk (hazard ratio [HR], 1.33; confidence interval [CI], 1.10-1.60; P-value, 0.005) and higher three-year mortality (HR 1.18; CI 1.01-1.38; P-value, 0.038). In subgroup analysis, the risk of one-year mortality by PACE became greater with higher-risk surgical procedures (HR 1.20; CI 1.04-1.39; P-value, 0.020 for low-risk surgery, HR 1.69; CI 1.45-1.96; P-value, <0.001 for intermediate-risk, and HR 2.38; CI 1.47-3.86; P-value, 0.034 for high-risk).
A nationwide multicenter study showed that PACE was significantly associated with increased one-year mortality. This association was stronger in high-risk surgery, older, male, and chronic kidney disease subgroups. Further studies to improve mortality associated with PACE are needed.
Key Words: Non-cardiac surgery; Cardiac event; Mortality
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