[Impact of preoperative cardiology consultation on major adverse cardiac events in non-cardiac surgery patients: a retrospective cohort study].

OBJECTIVES

To investigate whether preoperative cardiology consultation reduces the incidence of major adverse cardiac events (MACE) in patients undergoing non-cardiac surgeries.

METHODS

This cohort study was conducted among 7019 elderly patients (above 65 years) with abnormal ECGs undergoing non-cardiac surgeries. The main outcome was MACE occurrence within 30 days post-surgery. The patients were divided into model development and validation cohorts in a 7:3 ratio, and each cohort was categorized into two subgroups with high-risk and low-risk abnormal ECG. MACE prediction models were constructed for the subgroups, and their predictive power was evaluated using ROC curves; the value of preoperative cardiology consultation for reducing MACE was assessed using decision curve analysis.

RESULTS

Among the 4914 patients in the model development cohort, 61 of the 3010 patients with low-risk abnormal ECGs experienced MACE (2.0%), as compared with 59 out of 1904 patients (3.1%) in the high-risk group. The predictive model for MACE for the low-risk group contained 6 risk factors (AUC=0.772), and that for the high-risk group contained 5 risk factors (AUC=0.769). In patients with low-risk abnormal ECG, undergoing cardiovascular specialist consultation did not show significant benefits (the survival rate for predicting MACE was 0.02). However, in patients with high-risk abnormal ECG and those with low-risk abnormal ECG but having specific risk factors, undergoing cardiovascular specialist consultation showed significant benefits with survival rates for predicting MACE of 0.3 and 0.229, respectively.

CONCLUSIONS

For patients with high-risk abnormal ECG and those with low-risk abnormal ECG and specific risk factors, preoperative cardiology consultation may help to reduce the occurrence of MACE following non-cardiac surgeries, but for patients with simple low-risk abnormal ECG cases without risk factors, preoperative cardiology consultation can be omitted, which does not affect the incidence of MACE but can improve medical efficiency.