TY - JOUR
T1 - Cardiac risk of noncardiac surgery
T2 - Influence of coronary disease and type of surgery in 3368 operations
AU - Eagle, Kim A.
AU - Rihal, Charanjit S.
AU - Mickel, Mary C.
AU - Holmes, David R.
AU - Foster, Eric D.
AU - Gersh, Bernard J.
PY - 1997/9/16
Y1 - 1997/9/16
N2 - 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.
AB - 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.
KW - Myocardial infarction
KW - Revascularization
KW - Surgery
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U2 - 10.1161/01.CIR.96.6.1882
DO - 10.1161/01.CIR.96.6.1882
M3 - Article
C2 - 9323076
AN - SCOPUS:0030880773
SN - 0009-7322
VL - 96
SP - 1882
EP - 1887
JO - Circulation
JF - Circulation
IS - 6
ER -