Association of thrombogenicity indices with perioperative cardiovascular events after non-cardiac surgery: a prespecified analysis of the PANDA study

Abstract Traditional clinical risk models, such as Revised Cardiac Risk Index (RCRI), have limited predictive value for estimating postoperative cardiovascular complications following non-cardiac surgery. This analysis aimed to evaluate prognostic value of thrombogenicity profiles and coronary anatomy for cardiovascular events in patients undergoing non-cardiac surgery. In a prospective cohort of 120 patients who underwent intermediate-to-high risk surgery, thrombogenicity profiles were assessed using thromboelastography (TEG®) and conventional hemostatic measurements before surgery. Coronary artery disease (CAD) was preoperatively defined as presence of significant stenosis (≥ 50% luminal narrowing) on coronary computed tomography angiography (CCTA). Postoperative cardiovascular events were defined as cardiovascular death, non-fatal myocardial infarction, myocardial injury, pulmonary edema, non-fatal stroke, and systemic embolism within 30 days after surgery. Sixteen patients (13.3%) experienced cardiovascular events. In multivariable analysis, presence of CAD (odds ratio [OR]: 5.11; 95% confidence interval [CI]: 1.49–17.53; P = 0.009), D-dimer (per 1-μg/mL increase: OR: 1.22; 95% CI: 1.02–1.47; P = 0.030), and platelet–fibrin clot strength (PFCS) measured by TEG® (per 1-mm increase: OR: 1.10; 95% CI: 1.01–1.20; P = 0.027) were independently associated with cardiovascular events. Discrimination of cardiovascular event risk improved progressively with the sequential addition of the following risk stratification models: RCRI alone, RCRI + CCTA, and RCRI + CCTA + thrombogenicity profiles (C-index: 0.660 vs. 0.731 vs. 0.803). Cardiovascular event rates increased with greater risk burden, ranging from 4.2% in patients with no risk components to 77.8% in those with all components present. Integrating thrombogenicity assessment and CCTA with traditional clinical risk models may improve perioperative risk stratification and help guide tailored preventive strategies for patients undergoing non-cardiac surgery. Clinical trial registration . URL: http://www.clinicaltrials.gov . Unique identifier: NCT02250963. Graphical Abstract Sequential integration of thrombogenicity profiles and coronary anatomy assessed by CCTA improves perioperative cardiovascular risk prediction beyond clinical risk stratification alone in patients undergoing non-cardiac surgery. CAD = coronary artery disease; CCTA = coronary computed tomography angiography; CI = confidence interval; CV = cardiovascular; MI = myocardial infarction; MINS = myocardial injury in non-cardiac surgery; PFCS = platelet–fibrin clot strength; RCRI = Revised Cardiac Risk Index; TEG® = thromboelastography.