Symptomatic acute coronary syndrome in a cohort of patients followed after noncardiac surgery

Objetives To determine the incidence of acute coronary syndrome (ACS) with and without ST-segment elevation, factors related to the development of ACS, mean hospital stay, and attributable mortality. Material and methods In a noncardiac surgery cohort attended in the postoperative critical care unit of Hospital General de la Ciudad Real, Spain, data were recorded prospectively between April 2006 and December 2009. The incidence of symptomatic ACS was calculated. Results Thirty-two of 1919 patients developed ACS (incidence, 1.7%). Patient factors related to developing the syndrome were male sex (P =.046), age (P =.001), arterial hypertension (68.8%, P =.012), and a history of ischemic heart disease (34.4%, P =.001). Types of surgery that were significantly related to developing ACS were general surgery (37.5%), orthopedic or trauma surgery (28.1%), and vascular surgery (15.6%) (P <.004). Twenty percent of the cohort received transfusions; 50% of those who developed ACS were transfused (P =.001). The condition was treated medically in 87.5% of the cases. The mean (SD) duration of hospital stay was 2.96 (6.3) days for the cohort and 3.88 (5) days for patients who developed ACS (P =.39); mortality rates were 5% and 6%, respectively (P =.45). Multivariate analysis confirmed that the following independent variables were associated with developing postoperative ACS: a history of ischemic heart disease (odds ratio [OR], 4.59; 95% confidence interval [CI], 1.98–10.62) and intraoperative bleeding (OR, 3.18; 95% CI, 1.51–6.71). Gynecologic surgery patients were the least likely to develop postoperative ACS (OR, 0.063; 95% CI, 0.004–1.09). Conclusions The incidence of postoperative ACS in this noncardiac surgery cohort was 1.7%. Age, male sex, a history of arterial hypertension or ischemic heart disease, type of surgery, and intraoperative bleeding requiring transfusion of packed red blood cells are factors that are associated with developing this complication. Given the seriousness of ACS it is important to classify patients by risk before surgery.