Late-breaking results from the VISION study, presented early this week at the European Society of Cardiology (ESC)’s annual symposium, found nearly three-quarters of patient deaths after noncardiac surgery can be attributed to cardiovascular causes.
The VISION trial enrolled more than 40,000 patients aged 45 years and up who were undergoing cardiac surgery and would be in the hospital for at least one night, according to an ESC release. Patients were recruited from 27 centers in 14 countries across six continents and monitored for complications during the month after their procedures.
Just under 2 percent of all patients died in-hospital in the 30 days following noncardiac surgery, study author Jessica Spence, of the Population Health Research Institute in Hamilton, Ontario, Canada, said in the release. Almost all fatalities occurred outside of the operating room.
“There’s a false assumption among patients that once you’ve undergone surgery, you’ve ‘made it,’” she said. “Unfortunately that’s not always the case, and now we have a much better sense of when and why people die after noncardiac surgery. Most deaths are linked to cardiovascular cases.”
Indeed, Spence et al.’s research found eight perivascular complications—five of which were cardiovascular—that were linked to death after noncardiac surgery. Myocardial infarction was the most common complication, affecting 29 percent of patients, though it was followed closely by major bleeding and sepsis.
“We’re letting patients down in postoperative management,” principal investigator Philip J. Devereux, a professor and director of cardiology at McMaster University in Canada, said in the release. “The study suggests that most deaths after noncardiac surgery are due to cardiovascular causes, so cardiologists have a major role to play to improve patient safety. This includes conducting blood and imaging tests to identify patients at risk, then giving preventive treatment, including medications that prevent abnormal heart rhythms, lower blood pressure and cholesterol and prevent blood clots.”
Earlier findings from the VISION trial proved a blood test alone was enough to detect MI risk in patients undergoing noncardiac surgery, meaning clinicians could intervene as soon as they’re aware of increased levels of high-sensitivity troponin T in the patient’s bloodstream.
The authors said myocardial infarction after surgery independently raised the risk for 30-day mortality by 2.6-fold, and stroke increased risk 1.6-fold. Major bleeding, congestive heart failure, deep venous thrombosis and acute kidney injuries also boosted risk.
“Combined, these discoveries tell us that we need to become more involved in care and monitoring after surgery to ensure that patients at risk have the best chance for a good recovery,” Spence said.
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.