The objective of this study is to evaluate the efficacy of the modified shock index (MSI) in predicting the incidence of postoperative cardiovascular events (PCEs) in patients with pre-existing cardiac disease undergoing non-cardiac surgery. A retrospective analysis was performed on the clinical data of patients who underwent gastric, colorectal, and hepatobiliary surgeries at Union Hospital Affiliated to Fujian Medical University between January 2020 and December 2025. Baseline characteristics, intraoperative vital signs, occurrence of postoperative cardiac complications, and total postoperative hospital stay were reviewed and summarized to assess the predictive performance of the MSI for PCEs in this patient population.
Inclusion Criteria:
(1) Age ≥45 years. (2) Underwent elective major abdominal surgery with a duration of ≥2 hours at Fujian Medical University Union Hospital between January 2020 and December 2025.
(3) Presence of any of the following: history of heart disease; elevated BNP or cardiac troponin within 30 days before surgery; or at least two cardiac risk factors.
(4) Complete electronic medical records available.
Exclusion Criteria:
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After major abdominal surgery, patients meeting any of the following are assigned to the event group: Myocardial injury/infarction: Postoperative cTnT above upper limit, ± new ischemic ECG changes, new wall motion abnormality on echocardiography, or pulmonary edema on chest X-ray; cTnT elevation without non-cardiac cause = myocardial injury after non-cardiac surgery. Acute heart failure: Dyspnea/crackles needing diuretic/vasodilator, plus ≥1 of: BNP \>400 pg/mL, NT-proBNP \>1800 pg/mL, pulmonary congestion/edema on chest X-ray, or echocardiography showing LVEF drop ≥10% or acute diastolic worsening. Serious arrhythmia: Sustained ventricular tachycardia/fibrillation needing urgent intervention; new rapid atrial fibrillation with hemodynamic instability; high-degree atrioventricular block needing temporary pacing; or resuscitated cardiac arrest. Cardiac death: Death due to above events, supported by cTnT, BNP, ECG, echocardiography, or chest X-ray, excluding definite non-cardiac causes.
After major abdominal surgery, patients are assigned to the non-event group if none of the above events occurred. They must also meet: peak postoperative cTnT remains normal, or if mildly elevated, a definite non-cardiac cause is identified with no cardiovascular symptoms or treatment; no diagnosis or treatment for acute heart failure, serious arrhythmia, or cardiac death documented; isolated mild BNP elevation without clinical significance, occasional premature beats, or other non-urgent findings are not counted as events.
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