Background Preoperative electrocardiogram (ECG) is one of the important methods for
perioperative assessment. It can reflect the patient's cardiac condition to a certain
extent and indicate the potential risk of major adverse cardiac events (MACE). When a
patient has an abnormal preoperative ECG, the standard medical procedure is to consult
with a cardiologist to assess cardiac risk and adjust cardiac function, thereby reducing
the incidence of adverse cardiac events. However, some studies suggest that cardiology
consultation may delay surgery for elderly fracture patients and that consultation does
not affect the prognosis of some abdominal surgery patients. Conversely, other studies
indicate that cardiology consultation can reduce the incidence of adverse cardiac events
in patients undergoing major vascular surgery. Additionally, when the patient has a
normal ECG, cardiology consultation is usually not provided. Yet, elderly patients often
have multiple chronic diseases, and a normal ECG does not completely rule out cardiac
problems, which significantly increases the incidence of adverse cardiac events.
Therefore, identifying risk factors to reduce the incidence of adverse cardiac events in
elderly non-cardiac surgery patients is particularly important.
Objectives:
To investigate the circumstances in which preoperative cardiology consultation is needed
to reduce the incidence rate of MACE.
Methods:
MACE was defined as the composite of acute myocardial infarction (MI), unstable angina,
heart failure (HF), new-onset severe arrhythmia, nonfatal cardiac arrest, and cardiac
death, occurring during or within 30 days following non-cardiac surgery. MACE cases were
identified by reviewing medical records. Structured query language (SQL) was employed to
extract relevant data elements, including postoperative biochemical tests,
electrocardiograms (ECGs), coronary angiograms, postoperative progress notes, and
consultation reports. Patients could experience multiple MACE events. Three experienced
clinicians conducted independent evaluations of complications. Any discrepancies were
resolved through discussion and consensus. This cohort study involved non-cardiac surgery
patients from the First Medical Center of the Chinese PLA General Hospital, covering the
period from January 2015 to August 2019. Preoperative cardiology consultation was
considered as a mediating variable. By modeling, the confounding factors and risk factors
for MACE were identified, and the impact of cardiology consultation as a mediating factor
on the incidence of postoperative MACE was evaluated. Additionally, the study aimed to
identify which categories of ECG findings necessitate cardiology consultation to reduce
the incidence of adverse cardiac events, thereby optimizing the cardiology consultation
process.
