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An elevated risk of arterial ischemic events following non-cardiac surgery has been demonstrated in various studies,1 as has the association of elevated troponin levels with 30-day mortality.2 Additionally, cancer patients face an augmented risk of cardiovascular complications, likely attributable to treatments associated with their disease.3 There is a lack of data on the risk of cardiovascular complications following surgery for different cancers. The aim of this observational cohort study was to improve pre- and postoperative management of cardiovascular complications, tailored for different cancers.
At present, risk assessment is performed routinely based on background comorbidities without taking tumor type into consideration. In this article, we show that different tumor types possess different risk for myocardial infarction or ischemic stroke. Furthermore, we show that in certain tumors, the transient increase of risk is short, up to 1 week after surgery, whereas in some cancers the risk persists over a longer time.4
In the future, prospective evaluation of preoperative risk factors is needed to enable selection of patients who need more comprehensive cardiovascular risk assessment before surgery, including intervention. Additionally, it is essential to evaluate the protective effects of antithrombotic medication on outcome incidences.
References
Devereaux PJ, Sessler DI. Cardiac complications in patients undergoing major noncardiac surgery. N Engl J Med. 2015;373(23):2258–69.
Devereaux PJ, Chan MT, Alonso-Coello P, et al. Association between postoperative troponin levels and 30-day mortality among patients undergoing noncardiac surgery. JAMA. 2012;307(21):2295–304.
Navi BB, Reiner AS, Kamel H, et al. Risk of arterial thromboembolism in patients with cancer. J Am Coll Cardiol. 2017;70(8):926–38.
Rautiola J, Björklund J, Zelic R, et al. The risk of postoperative ischemic stroke and myocardial infarction in patients operated for cancer. Ann Surg Oncol. 2023. https://doi.org/10.1245/s10434-023-14688-6.
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Henrik Falconer is a Board Member of Surgical Science. Juhana Rautiola, Johan Björklund, Renata Zelic, Gustaf Edgren, Matteo Bottai, Magnus Nilsson, Per Henrik Vincent, Hanna Fredholm, Annika Sjövall, Per J. Nilsson, Peter Wiklund, Markus Aly, and Olof Akre have no disclosures to declare in relation to this work.
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This article refers to: Rautiola J, Björklund J, Zelic R, et al. The risk of postoperative ischemic stroke and myocardial infarction in patients operated for cancer. Annals Surgical Oncology. In press.https://doi.org/10.1245/s10434-023-14688-6.
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Rautiola, J., Björklund, J., Zelic, R. et al. ASO Author Reflections: Arterial Ischemic Events Following Cancer Surgery: Where Do We Stand?. Ann Surg Oncol 31, 1789–1790 (2024). https://doi.org/10.1245/s10434-023-14816-2
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DOI: https://doi.org/10.1245/s10434-023-14816-2