Cardiac risk of noncardiac surgery: Influence of coronary disease and type of surgery in 3368 operations

Kim A. Eagle, Charanjit Rihal, Mary C. Mickel, David Holmes, Eric D. Foster, Bernard J. Gersh

Research output: Contribution to journalArticle

337 Citations (Scopus)

Abstract

Background: The influence of prior coronary artery bypass surgery (CABG) versus medical therapy for reducing the risk of postoperative cardiac complications after noncardiac surgery continues to be debated. To further clarify this controversy we studied 24 959 participants in the Coronary Artery Surgery Study (CASS) database with suspected coronary disease by identifying those who required noncardiac surgery during more than 10 years of follow-up. Methods and Results: CASS registry enrollees were either treated with CABG or medical therapy after initial entry. During follow-up, patients who required noncardiac operations were evaluated for hospital death or out-of-hospital death within 30 days of noncardiac surgery and nonfatal postoperative myocardial infarction (MI). At a mean follow-up of 4.1 years, 3368 patients underwent noncardiac surgery, with abdominal (36%), urologic (21%), orthopedic (15%), and vascular being most common. Abdominal, vascular, thoracic, and head and neck surgery each had a combined MI/death rate among patients with nonrevascularized coronary disease >4%. Among 1961 patients undergoing higher-risk surgery, prior CABG was associated with fewer postoperative deaths (1.7% versus 3.3%, P=.03) and MIs (0.8% versus 2.7%, P=.002) compared with medically managed coronary disease. Contrariwise, 1297 patients undergoing urologic, orthopedic, breast, and skin operations had mortality of <1% regardless of prior coronary treatment. Prior CABG was most protective in patients with advanced angina and/or multivessel coronary artery disease. Conclusions: In patients with known coronary artery disease, noncardiac surgeries involving the thorax, abdomen, vasculature, and headland neck are associated with the highest cardiac risk, which is reduced among patients with prior CABG.

Original languageEnglish (US)
Pages (from-to)1882-1887
Number of pages6
JournalCirculation
Volume96
Issue number6
StatePublished - Sep 16 1997
Externally publishedYes

Fingerprint

Coronary Disease
Coronary Artery Bypass
Orthopedics
Blood Vessels
Coronary Artery Disease
Coronary Vessels
Neck
Thorax
Myocardial Infarction
Mortality
Ambulatory Surgical Procedures
Abdomen
Registries
Breast
Therapeutics
Head
Databases
Skin

Keywords

  • Myocardial infarction
  • Revascularization
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Eagle, K. A., Rihal, C., Mickel, M. C., Holmes, D., Foster, E. D., & Gersh, B. J. (1997). Cardiac risk of noncardiac surgery: Influence of coronary disease and type of surgery in 3368 operations. Circulation, 96(6), 1882-1887.

Cardiac risk of noncardiac surgery : Influence of coronary disease and type of surgery in 3368 operations. / Eagle, Kim A.; Rihal, Charanjit; Mickel, Mary C.; Holmes, David; Foster, Eric D.; Gersh, Bernard J.

In: Circulation, Vol. 96, No. 6, 16.09.1997, p. 1882-1887.

Research output: Contribution to journalArticle

Eagle, KA, Rihal, C, Mickel, MC, Holmes, D, Foster, ED & Gersh, BJ 1997, 'Cardiac risk of noncardiac surgery: Influence of coronary disease and type of surgery in 3368 operations', Circulation, vol. 96, no. 6, pp. 1882-1887.
Eagle, Kim A. ; Rihal, Charanjit ; Mickel, Mary C. ; Holmes, David ; Foster, Eric D. ; Gersh, Bernard J. / Cardiac risk of noncardiac surgery : Influence of coronary disease and type of surgery in 3368 operations. In: Circulation. 1997 ; Vol. 96, No. 6. pp. 1882-1887.
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