Perioperative cardioprotection as a measure to reduce the risk of posthospital cardiovascular complications (cohort study)

The objective was to study the incidence of the late cardiovascular complications depending on the use of perioperative cardioprotection in patients with high cardiac risk. Materials and methods. We analyzed data of medical cards and telephone interviews of 307 patients aged 47 to 85 (67 [63–71]) years who underwent surgical procedures a year before the interview. Perioperative pharmacological cardioprotection (dexmedetmidine or phosphocreatin) was used in 168 (54.7 %) patients. The endpoints of the study were composite outcome (one or more cardiac events), MACCE (cardiac mortality, myocardial infarction, stroke or a combination of these) and 1-year cardiac mortality. To process the data, we used logistic regression with the calculation of the odds ratio (OR) and 95% confidence interval (95% CI) and ROC analysis. Results. During 12 months after vascular surgery, various cardiac events (composite outcome) developed in 29.3 % of patients, including MACCE in 11.4 % of cases and cardiac mortality in 3.3 %. Patients who received and did not receive cardioprotection had a different risk of composite outcome (OR 0.5392, 95 % CI 0.3287–0.8846, р=0.014) and risk of MACCE (OR 0.4835, 95 % CI 0.2372–0.9852, p = 0.041). Perioperative cardioprotection had no effect on the risk of 1-year cardiac mortality (OR 0.3994, 95 % CI 0.1177–1.3556, р = 0.125). Conclusion. Within one year after vascular surgery, more than 29 % of patients with high cardiac risk develop one or more cardiac events (composite outcome), including cardiac mortality in 3.3 % of cases. Perioperative cardioprotection with dexmedetomidine or phosphocreatine reduces the risk of composite outcome and the risk of MACCE, without reducing one year cardiac mortality.