Association of Intraoperative Hemodynamic Instability and Myocardial Injury Biomarkers With Major Adverse Cardiovascular Events After Cardiac Surgery: A Prospective Cohort Study

Background: Major adverse cardiovascular events (MACE) remain important complications following cardiac surgery. Intraoperative hemodynamic instability and myocardial injury biomarkers may contribute to postoperative cardiovascular risk. This study aimed to evaluate their association with MACE among cardiac surgical patients. Methods: This prospective observational cohort study included 120 patients undergoing cardiac surgery at Sardar Fateh Muhammad Khan Buzdar Institute of Cardiology, Dera Ghazi Khan, and Ayub Medical College, Abbottabad, Pakistan, from January 2025 to January 2026. Intraoperative hemodynamic parameters, postoperative high-sensitivity cardiac troponin, and creatine kinase-MB were evaluated. Patients were monitored for MACE during 30-day followup. Multivariable logistic regression assessed associated factors. Results: In the dataset, MACE occurred in 32 patients (26.7%). Hypotensive episodes were significantly more frequent among patients experiencing MACE (2.9 ± 1.7 versus 2.2 ± 1.6; p=0.044). Hypotension duration was greater in the MACE group, although statistically insignificant (p=0.073). Postoperative troponin and CK-MB concentrations showed no significant differences. Hypotension duration (aOR 1.32; p=0.118) and troponin (aOR 0.95; p=0.685) were not independently associated with MACE. The combined predictive model demonstrated limited discrimination (AUC=0.620). Conclusion: findings suggest that intraoperative hypotensive episodes may accompany postoperative cardiovascular complications, whereas myocardial injury biomarkers demonstrated limited independent predictive value. Larger prospective investigations using observed clinical data are necessary to establish reliable cardiovascular risk predictors and improve perioperative patient assessment and postoperative monitoring strategies.