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[Risk analysis of cardiovascular events in elderly hypertensive patients with different risk stratification during
Jiru Zhang1, Zhiqiang Wang, Yong Ji
1Department of Anesthesiology, Affiliated Hospital of Jiangnan University, Wuxi No. 4 People's Hospital, Wuxi 214062, China;
Insights
Elderly hypertensive patients face increased cardiovascular event risks during surgery. General anesthesia significantly inhibits cardiovascular function, raising the likelihood of myocardial ischemia and arrhythmia, especially within 24 hours post-operation.
Area of Science:
- Cardiology
- Anesthesiology
- Geriatrics
Background:
- Elderly patients with hypertension are susceptible to perioperative cardiovascular events.
- Risk stratification is crucial for managing these patients.
Purpose of the Study:
- To investigate the perioperative cardiovascular event risks in elderly hypertensive patients across different risk strata.
- To assess the impact of general anesthesia on cardiovascular function in this population.
Main Methods:
- 126 elderly hypertensive patients were stratified into three risk groups (in danger, high-risk, very high-risk) and compared to a control group.
- Cardiovascular parameters (CI, CO, SV, SVR, Vpk, HR, MAP) were monitored using an ultrasonic cardiac output monitor (USCOM).
- Myocardial ischemia and arrhythmia were assessed via dynamic electrocardiography (DCG) pre- and post-operatively.
Main Results:
- Higher incidences of myocardial ischemia and arrhythmia were observed in all three risk groups compared to controls, particularly within 24 and 48 hours post-operation.
- Ischemia frequency and duration, along with arrhythmia incidence, progressively increased with higher risk stratification.
- Significant differences (P < 0.05) were noted between groups for all monitored cardiovascular events.
Conclusions:
- Perioperative cardiovascular event risk is significantly elevated in elderly hypertensive patients.
- General anesthesia markedly inhibits cardiovascular function, increasing susceptibility to myocardial ischemia and arrhythmia, especially in the immediate 24-hour postoperative period.
Objective:
To study the risks of cardiovascular events of elderly hypertensive patients with different risk stratification during the perioperative period.
Methods:
126 elderly hypertensive patients without cardiac surgery were selected and divided into following 3 groups: group I (in danger), group II (high-risk), group III (very high-risk), each group with 42 cases. Control group was randomly selected 42 elderly patients without hypertension and other cardiovascular risk factors. Sevoflurane, Etomidate, Propofol, Cisatracurium Besilate for Injection, Fentanyl were used to induction and maintenance of anesthesia. Patients' cardiac index (CI), cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), peak velocity (Vpk), heart rate (HR), mean arterial pressure (MAP) were monitored by ultrasonic cardiac output monitor (ultrasonic cardiac output monitor, USCOM). Pre- and post-operative myocardial ischemia and arrhythmia were monitored by dynamic electrocardiogram (dynamic electrocardiography, DCG).
Results:
Incidence myocardial（9.5%, 31.0%, 40.5%), ischemia frequency [(10.4 ± 1.7) time, 13.3 ± 1.9) time, 17.4 ± 2.3) time], ischemic time [(116.4 ± 9.7) min, (174.3 ± 19.8) min, (212.4 ± 20.5) min] and arrhythmias incidence (28.6%, 52.4%, 92.9%) were specially more significant for group I, group II and group III patients within the postoperative 24 hours (P < 0.05). Comparison between group I, group II and group III each other, myocardial ischemia incidence (11.9%, 21.4%, 31.0%), ischemia frequency [(9.5 ± 1.5) time, (11.6 ± 2.0) time, (15.0 ± 2.2) time], ischemic time [(98.5 ± 9.4) min, (158.3 ± 16.7) min, (198.0 ± 18.1) min] and arrhythmias incidence (16.7%, 45.2%, 81.0%) gradually increased for 3 groups within the postoperative 48 hours (P < 0.05).
Conclusion:
Risk of cardiovascular events significantly increases for elderly patients with cardiovascular high-risk factors in the perioperation period, and especially cardiovascular function is inhibited most obviously in the general anesthesia intubation immediately before and after 24 hours and is prone to cardiovascular events, such as myocardial ischemia and arrhythmia.
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