Relation of Previous Coronary Artery Bypass Grafting and/or Percutaneous Coronary Intervention to Perioperative Cardiovascular Outcomes in Patients Who Underwent Noncardiac Surgery

被引:0
|
作者
Singh, Nina [1 ]
Berger, Jeffrey S. [1 ,2 ]
Smilowitz, Nathaniel R. [1 ,3 ]
机构
[1] New York Univ, Dept Med, Leon H Charney Div Cardiol, Grossman Sch Med, 550 1St Ave, New York, NY 10016 USA
[2] New York Univ, Dept Surg, Grossman Sch Med, New York, NY 10016 USA
[3] Vet Affairs New York Harbor Healthcare Syst, Dept Med, New York, NY 10010 USA
来源
AMERICAN JOURNAL OF CARDIOLOGY | 2022年 / 170卷
基金
美国国家卫生研究院;
关键词
MAJOR VASCULAR-SURGERY; REVASCULARIZATION; RISK; DISEASE;
D O I
10.1016/j.amjcard.2022.01.017
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Patients with ischemic heart disease frequently undergo noncardiac surgery. We examined perioperative surgical outcomes in patients with and without previous coronary revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Adults >= 45 years old who underwent noncardiac surgery between 2010 and 2014 were identified from the National Inpatient Sample. Previous CABG and PCI were identified using International Classification of Diseases, Ninth Revision codes. Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as the composite of in-hospital mortality, acute myocardial infarction, and acute ischemic stroke. Multivariable logistic regression models were used to estimate associations between previous coronary revascularization and surgical outcomes after adjustment for clinical covariates. We identified 25,091,140 hospitalizations for noncardiac surgery, of which 8.4% had a history of coronary revascularization (47% previous CABG without PCI, 45% previous PCI without CABG, and 8% previous CABG and PCI). Hospitalized patients with versus without previous coronary revascularization had a higher crude incidence (4.0% vs 2.6%, p < 0.001) but lower odds of MACCE (adjusted odds ratio 0.96, 95% CI 0.94 to 0.98) driven by a lower risk of death and ischemic stroke. When analyzed by revascularization strategy, lower odds of MACCE were restricted to patients with previous CABG, driven by excess perioperative acute myocardial infarction risks after PCI. In patients with established cardiovascular disease, previous coronary revascularization was associated with lower odds of MACCE (adjusted odds ratio 0.76, 95% CI 0.75 to 0.78), regardless of revascularization strategy. In conclusion, previous coronary revascularization is associated with lower odds of MACCE after noncardiac surgery, but perioperative risks vary by mode of coronary revascularization. Published by Elsevier Inc.
引用
收藏
页码:40 / 46
页数:7
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