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Published on: June 16, 2014
Cardiovascular-Kidney-Metabolic Syndrome: Association with Adverse Events After Major Noncardiac Surgery
Sebastian Roth1,2, René M'Pembele1,2, Purificación Matute3
1From the Department of Anesthesiology, University Hospital Duesseldorf, Heinrich Heine University Duesseldorf, Duesseldorf, Germany.
Insights
The new cardiovascular-kidney-metabolic (CKM) syndrome is linked to higher risks of major adverse cardiovascular events and death following noncardiac surgery. Early identification and management of CKM syndrome are crucial for improving patient outcomes in surgical settings.
Area of Science:
- Cardiology
- Nephrology
- Metabolic Disorders
- Perioperative Medicine
Background:
- The American Heart Association (AHA) introduced the cardiovascular-kidney-metabolic (CKM) syndrome to unify understanding of interconnected heart, kidney, and metabolic conditions.
- CKM syndrome represents a complex interplay of chronic diseases that may impact patient outcomes in various clinical settings.
Purpose of the Study:
- To investigate the impact of the newly defined CKM syndrome on patient outcomes after noncardiac surgery.
- To assess the association between CKM syndrome stages and major adverse cardiovascular events (MACE), mortality, and other complications.
Main Methods:
- Secondary analysis of a prospective international cohort study involving 14,634 patients aged ≥45 years with increased cardiovascular risk undergoing noncardiac surgery.
- Exposure was defined by the AHA's CKM syndrome criteria. Primary endpoint was 30-day MACE; secondary endpoints included all-cause mortality and severe non-MACE complications.
- Multivariate logistic regression was used to determine independent associations between CKM stage and adverse outcomes.
Main Results:
- Patients with CKM stage ≥3 showed significantly higher rates of MACE (OR 2.26), mortality (OR 1.42), and non-MACE complications (OR 1.11) compared to those without CKM syndrome.
- Incidence of MACE varied by CKM stage, with higher stages (e.g., 4b: 4.7%) indicating increased risk.
- The study included a large cohort (n=14,634) with a mean age of 72 years, predominantly male (60.8%).
Conclusions:
- The CKM syndrome is significantly associated with increased morbidity and mortality following noncardiac surgery.
- Cardiovascular, renal, and metabolic health should be considered collectively in patients undergoing noncardiac procedures.
- The findings underscore the importance of recognizing and managing CKM syndrome in the perioperative setting.
Background:
The American Heart Association (AHA) recently defined the cardiovascular-kidney-metabolic syndrome (CKM) as a new entity to address the complex interactions between heart, kidneys, and metabolism. The aim of this study was to assess the outcome impact of CKM syndrome in patients undergoing noncardiac surgery.
Methods:
This is a secondary analysis of a prospective international cohort study including patients aged ≥45 years with increased cardiovascular risk undergoing noncardiac surgery. Main exposure was CKM syndrome according to the AHA definition. The primary end point was a composite of major adverse cardiovascular events (MACE) 30 days after surgery. Secondary end points included all-cause mortality and non-MACE complications (Clavien-Dindo class ≥3).
Results:
This analysis included 14,634 patients (60.8% male, mean age = 72±8 years). MACE occurred in 308 patients (2.1%), and 335 patients (2.3%) died. MACE incidence by CKM stage was as follows: CKM 0: 5/367 = 1.4% (95% confidence interval [CI], 0.4%-3.2%); CKM 1: 3/367 = 0.8% (95% CI, 0.2%-2.4%); CKM 2: 102/7440 = 1.4% (95% CI, 1.1%-1.7%); CKM 3: 27/953 = 2.8% (95% CI, 1.9%-4.1%); CKM 4a: 164/5357 = 3.1% (95% CI, 2.6%-3.6%); CKM 4b: 7/150 = 4.7% (95% CI, 1.9%-9.4%). In multivariate logistic regression, CKM stage ≥3 was independently associated with MACE, mortality, and non-MACE complications, respectively (MACE: OR 2.26 [95% CI, 1.78-2.87]; mortality: OR 1.42 [95% CI: 1.13 -1.78]; non-MACE complications: OR 1.11 [95% CI: 1.03-1.20]).
Conclusion:
The newly defined CKM syndrome is associated with increased morbidity and mortality after non-cardiac surgery. Thus, cardiovascular, renal, and metabolic disorders should be regarded in mutual context in this setting.
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