DG Journal Club
Acta Anaesthesiol Scand. 2022 Dec 12
Prolonged QTc interval has been linked to risk of arrhythmias and mortality in the general population. Preoperative electrocardiography (ECG) is often obtained for patient-and procedural cardiovascular risk assessment. The aim of this study was to investigate the association of preoperative QTc and all-cause mortality in non-cardiac surgical cohort.
A retrospective study of all patients over 18 years undergoing non-cardiac surgery at Landspitali – the National University Hospital in Iceland between January 2nd 2005 to December 31st 2015, with follow-up through May 20th 2016. Patients were separated into five categories according to their preoperative QTc interval ≤379, 380-439ms (reference group), 440ms-479ms, 480ms-519ms, ≥520ms. Primary outcome was long-term mortality and secondary outcome was 30-day mortality.
A total of 10,209 surgeries for 10,209 individuals were included. The median follow-up for mortality was 2691 days (IQR 1620 to 3705 days). Patients with longer QTc interval had a higher comorbidity burden, were more likely to undergo emergency surgery and were often prescribed cardiac medications. After adjustment for confounding variables, the hazard ratio for long-term mortality compared with reference (QTc 380-439ms) was 0.85 [CI: 0.66-1.09] for QTc ≤379, 1.08 [CI: 0.99-1.17] for QTc 440-479ms, 1.26 [CI: 1.10-1.43] for QTc between 480-519ms and 0.97 [CI: 0.78-1.21] for QTc ≥520ms. Compared with reference, only patients with QTc interval between 480-519ms had higher odds-ratio for 30-day mortality as odds ratio for other groups were following; 1.12 [CI: 0.18-3.8] for ≤379ms, 1.03 [CI: 0.70-1.51] for QTc 440-479ms, 1.64 [CI: 1.02-2.60] for QTc 480-519ms and 0.98 [0.44-2.06] for QTc ≥520ms.
Preoperative QTc between 480-519ms is associated with both higher long-term and 30-day mortality after non-cardiac surgery. The results suggest that this could reflect an underlying cardiovascular risk.
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