Abstract 180: Risks and Predictors of Ischemic/bleeding Complications in Cardiac Patients Undergoing Elective Non-cardiac Surgery - An Analysis of the Prague-14 Study

Objective: To assess risks and predictors of ischemic/bleeding complications in consecutive patients with at least one cardiovascular disease undergoing elective major non-cardiac surgery. Methods: Subgroup analysis of the PRAGUE-14 study was performed. This prospective study analyzed the impact of antithrombotic therapy interruption on outcomes in non-selected surgical patients with known cardiovascular disease. Logistic regression models were applied to assess the association between potential predictors and selected binary coded end-points (perioperative ischemia, bleeding and hospital mortality). Results: Study population consisted of 1200 patients, 742 of them underwent elective surgery; age (median) 72.0, 66.2% males, CAD in 396, stroke in 70, atrial fibrillation in 209, venous thromboembolism (VTE) in 55, valvular heart disease in 108, artificial valve in 18, cardiomyopathy in 13. Preoperatively, 62.0% patients were receiving betablockers, 55.1% ACE inhibitors, 32.9% statins. 84.6% of patients were treated with antithrombotic therapy i.e. 439 aspirin, 31 DAPT, 192 oral anticoagulants. Prophylaxis of VTE in perioperative period was applied in 93.5%. In-hospital ischemic complications occurred in 3% (vs 9.8% in acutely operated patients, p<0.001), bleeding complications in 10.90% (vs 12.0%, n.s.), and both of them in 0.7% (vs. 4.2%, p<0.001). Mortality of patients, who underwent planned surgery, was 2.2% (vs. 6.8% in acute surgery, p<0.001). Multivariate linear regression identified that pre-procedural anemia and history of (coronary or non-coronary) stent implantation were significantly related to ischemic complications. Periprocedural antithrombotic management has no impact on ischemic complications. Termination of warfarin less than 4 days before surgery was significantly related to the risk of bleeding. Conclusions: Risk of perioperative ischemic complications is significantly lower in cardiac patients who are undergoing non-cardiac surgery electively (in comparison to acutely), and this risk is significantly related to a history of preprocedural anemia and history of stent implantation. For prevention from periprocedural bleeding, warfarin should be discontinued more than 4 days before surgery