Oral Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2021

Association of Preeclampsia with Myocardial Injury Among Patients Undergoing Noncardiac Surgery: the PREECLAMPSIA-VISION study (#44)

Monica Zen 1 2 , Simone Marschner 3 , Woiciech Szczeklik 4 , Pavel S Roshanov 5 , Thushari I Alahakoon 1 2 , Clara Chow 3 , Philip J Devereaux 6 7 , Sarah D McDonald 8 , Vincent W Lee 2 3
  1. Westmead Institute for Maternal & Fetal Medicine, Westmead Hospital, Westmead, NSW, Australia
  2. University of Sydney, Westmead Hospital, Westmead, NSW, Australia
  3. Westmead Applied Research Centre, The University of Sydney, NSW, Australia
  4. Department of Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
  5. Division of Nephrology, Department of Medicine, London Health Sciences Centre, Ontario, Canada
  6. McMaster University, Department of Health Research Methods, Evidence, and Impact, Hamilton, Canada
  7. Population Health Research Institute, Hamilton, Canada
  8. Division of Maternal-Fetal Medicine, Departments of Obstetrics & Gynecology, Radiology, and Health Research Methods, Evidence, & Impact, McMaster University, Hamilton, Ontario, , Canada

Preeclampsia complicates 2-8% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. There is now a large body of evidence to suggest that preeclampsia is associated with long-term cardiovascular morbidity and mortality[1-3]. However, it is unknown whether preeclampsia is associated with increased post-operative cardiovascular morbidity and mortality in women. Major operations are estimated to occur at a rate of 4% of the world population per year,[4] with a worldwide estimated 234 million major surgical procedures undertaken yearly.[4] Given the large number of women worldwide undergoing surgery and the absence of studies investigating preeclampsia as a risk factor for postoperative cardiovascular morbidity and mortality, there was a need to evaluate the usefulness of preeclampsia in the perioperative assessment of surgical risk factors. We assessed whether a history of preeclampsia is an independent risk factor for myocardial injury after non-cardiac surgery (MINS) and mortality within the first 30 days after surgery. MINS was defined as prognostically relevant myocardial injury due to ischemia that occurred during or within 30 days after non-cardiac surgery.

This study was a sub-study of the VISION study, a large international multicentre cohort study of a representative sample of 40,004 patients recruited between August 2007 and November 2013. Participants were ≥45 years of age and underwent inpatient non-cardiac surgery. For our study, analyses were restricted to the 13,902 participants with a history of pregnancy.  Among these women, 976 (7.0%) had a history of preeclampsia.  We found that a history of preeclampsia was associated with an increased risk of MINS, with an adjusted hazard ratio of 1.26 (95% CI, 1.03-1.53; p=0.02), however preeclampsia was not significantly associated with 30-day mortality. We therefore suggest preeclampsia be considered in the pre-operative cardiovascular risk assessment of women.

 

  1. McDonald, S.D., et al., Cardiovascular sequelae of preeclampsia/eclampsia: a systematic review and meta-analyses. American Heart Journal, 2008. 156(5): p. 918-30.
  2. Bellamy, L., et al., Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ, 2007. 335(7627): p. 974.
  3. Brown, M.C., et al., Cardiovascular disease risk in women with pre-eclampsia: systematic review and meta-analysis. European Journal of Epidemiology, 2013. 28(1): p. 1-19.
  4. Weiser, T.G., et al., An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet, 2008. 372(9633): p. 139-44.