To analyze whether non-cardiac surgery in high-risk cardio-vascular patients induces a quantitative change in one or several leukocyte subpopulations and whether such changes are associated with perioperative cardio-vascular events.

Annually, there are more than 200 million surgeries worldwide (Weiser et al., 2016; Weiser et al., 2008). 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% (Devereaux et al., 2011). Possibilities to preoperatively identify patients at risk are limited (Devereaux und Sessler, 2015; Gillmann et al., 2014) and prophylactic interventions are not yet established or controversial (Devereaux und Sessler, 2015).

Selected leukocyte subpopulations have been demonstrated to be associated with higher risk for cardiovascular events (Berg et al., 2012; Cheng et al., 2008; Engelbertsen et al., 2012; Kotfis et al., 2015; Rogacev et al., 2011; Rogacev et al., 2012).The aim of this study is to analyze whether surgical stress (non-cardiac surgery) induces a quantitative change in one or several of these leukocyte subpopulations and whether quantitative changes are associated with perioperative cardiovascular events. Therefore, high-risk cardio-vascular patients scheduled for 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 cardio vascular events up to day 30. A telephone interview will be performed to detect cardiovascular events after discharge until post-OP day 30.

Inclusion Criteria:

• 18 years or older
• Coronary heart disease
• Non-cardiac surgery
• Inpatient treatment
• Informed consent

Exclusion Criteria:

• 17 years of age or younger
• Known pregnancy or breastfeeding
• Missing informed consent
• Ambulatory or day-case surgery
• Emergency surgery
• Acute or chronic leukemia
• Current leukocytosis
• Current aplasia or leukopenia
• Current GM-CSF treatment
• Carotid artery surgery
• History of splenectomy or indications of splenectomy
• Cortisone treatment within past 14 days
• History of organ transplantation
• Current immunosuppressive medication
• Chemotherapy completed less than 14 days ago
• Intraoperative dexamethasone application
• Entity which is part of the composite endpoint diagnosed within past 28 days

Patients admitted to University Hospital Heidelberg suffering coronary heart disease and scheduled for non-cardiac surgery