Pulmonary hypertension (PH) is present in 1 of every 125 patients undergoing major noncardiac surgery and is an important risk factor for perioperative adverse cardiovascular (CV) events, according to study results published in the American Journal of Cardiology.
Pulmonary hypertension is defined as a mean pulmonary artery pressure >25 mm Hg at rest and is strongly associated with morbidity and mortality in the perioperative period. Few studies have determined the prevalence and outcomes of patients with PH undergoing major noncardiac surgery; therefore, researchers sought to evaluate the incidence of perioperative adverse CV events after noncardiac surgery in patients with and without PH using a large administrative database of hospital admissions in the United States.
They found that of 17,853,194 hospitalizations for major noncardiac surgery, 143,846 patients (0.81%) had PH. Major adverse cardiovascular events (MACE) occurred in 8.3% of patients hospitalized with any diagnosis of PH compared with 2.0% of patients without PH (P <.001).
The MACE consisted of an increased frequency of death (4.4% vs 1.1%; P <.001) and nonfatal myocardial infarction (3.2% vs 0.6%; P <.001). Even after adjusting for demographics, clinical covariates, and surgery type, PH remained independently associated with MACE.
“In conclusion, PH is associated with perioperative [MACE],” stated the investigators.
They added that “meticulous preoperative assessment and planning, hemodynamic monitoring during the perioperative period, and appropriate postoperative care remain the cornerstones of care for patients with PH undergoing noncardiac surgery.”
Further research on the association between the mechanism and severity of PH and perioperative outcomes is needed.
Smilowitz NR, Armanious A, Bangalore S, Ramakrishna H, Berger JS. Cardiovascular outcomes of patients with pulmonary hypertension undergoing noncardiac surgery [published online February 8, 2019]. Am J Cardiol. doi:10.1016/j.amjcard.2019.02.006