The potential use of regulatory T cells as preoperative risk stratification tool is evaluated in order to improve clinical risk stratification and reduce perioperative morbidity and mortality.
Annually, there are more than 200 million surgeries worldwide. The POISE study revealed 5% of patients undergoing a non-cardiac surgery suffer perioperative myocardial infarcts going along with a perioperative mortality rate of about 11,6%. Possibilities to preoperatively identify patients at risk are limited and prophylactic interventions are not yet established or controversial. Selected leukocyte subpopulations have been demonstrated to be associated with higher risk for cardiovascular events. The aim of this study is to evaluate the potential use of regulatory T cells as preoperative risk stratification tool in order to improve clinical risk stratification and reduce perioperative morbidity and mortality. Therefore, high-risk cardiovascular patients scheduled for major non-cardiac surgery will be recruited. Blood will be drawn at predefined time points before surgery and up to three days postoperatively. Leukocytes will be analyzed by flow cytometry. During 30 day follow up adverse cardiovascular events will be recorded. ECGs will be recorded preoperatively and on post-OP day 3. High-sensitive cardiac Troponin T will be measured prior to the operation and on post-OP day one to three. The patient chart will be screened for cardiovascular events up to day 30. A telephone interview will be performed to detect cardiovascular events after discharge until post-OP day 30.
Study Type
OBSERVATIONAL
Enrollment
233
Department of Anaesthesiology, University Hospital Heidelberg
Heidelberg, Baden-Wurttemberg, Germany
Cardiovascular Events
Number of participants with Cardiovascular Events defined as occurrence of Cardiac Death and/or Myocardial Ischemia and/or Myocardial Infarction and/or Myocardial Injury After Non-cardiac Surgery (MINS) and/or Embolic Stroke and/or Thrombotic Stroke recorded until postoperative day 30. Definitions according to European Perioperative Clinical Outcome-(EPCO) definitions detected at postoperative visits, documented in patient chart or detected during telephone interview after 30 postoperative days
Time frame: 30 days postoperative
Peripheral vascular occlusion
Diagnosed by a radiologist based on the results of duplex ultrasonography, angiography or CT-angiography.
Time frame: 30 days postoperative
New onset atrial fibrillation
Number of participants with new electrocardiographic detection of atrial fibrillation in postoperative ECG and/or documented in patient charts
Time frame: 30 days postoperative
Acute kidney injury
Number of participants with acute kidney injury according to KDIGO guidelines
Time frame: 30 days postoperative
Congestive heart failure
Number of participants with congestive heart failure according to European Perioperative Clinical Outcome (EPCO) definitions
Time frame: 30 days postoperative
Cardiac death
Number of participants with cardiac Death defined as death because of new myocardial infarction or ischemia, or atrial or ventricular arrhythmias, or cardiogenic pulmonary edema, or pulmonary embolism detected at postoperative visits, documented in patient chart or detected during telephone interview after 30 postoperative days
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Time frame: 30 days postoperative
Myocardial Ischemia
Number of participants with myocardial ischemia defined as new electrocardiographic detection of myocardial ischemia in ECG and/or documented in patient charts which will be screened up to 30 postoperative days and/or detected during telephone interview after 30 postoperative days
Time frame: 30 days postoperative
Myocardial Infarction
Number of participants with Myocardial Infarction defined as an increase in serum cardiac biomarker values in combination with symptoms of ischemia or new/presumed new significant ST segment or T wave ECG changes or new left bundle branch block or development of pathological Q waves on ECG. Definition according to European Perioperative Clinical Outcome-(EPCO) definitions detected at postoperative visits, postoperative blood analyses, documented in patient chart or detected during telephone interview after 30 postoperative days
Time frame: 30 days postoperative
Myocardial Injury after Non-cardiac Surgery (MINS)
Number of participants with MINS defined as raise in postoperative hs-cTNT (high sensitivity cardiac troponin T) jugded due to myocardial ischemia detected at postoperative visits, documented in patient chart or detected during telephone interview after 30 postoperative days
Time frame: 30 days postoperative
Stroke
Number of participants with embolic or thrombotic stroke defined cerebral event with persistent residual motor, sensory or cognitive dysfunction detected at postoperative visits, documented in patient chart or detected during telephone interview after 30 postoperative days
Time frame: 30 days postoperative