Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty

Alexandru Gottlieb, Mounir F Banoub, Juraj Sprung, Pavel J. Levy, Michael Beven, Edward J. Mascha

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Objective: Patients with coronary artery disease (CAD) who undergo noncardiac surgery are at increased risk for perioperative myocardial infarction (PMI). Undergoing successful coronary artery bypass grafting (CABG) before such surgery has been shown to decrease perioperative cardiac morbidity and mortality. Percutaneous transluminal coronary angioplasty (PTCA) is an alternative treatment for these patients. Perioperative cardiac morbidity in patients with CAD who underwent PTCA before their vascular surgery was reviewed. Setting: A tertiary care referral center for patients with cardiovascular heart disease. Participants: Review of vascular surgery database for patients who underwent vascular surgery preceded by PTCA between 1984 and 1995. Patients were excluded if they had a history of CABG within 2 years of surgery, had PTCA more than 18 months before surgery, or had incomplete data. Measurements: Data were collected concerning cardiac history, left ventricular (LV) function, perioperative cardiac morbidity (angina, MI, congestive heart failure [CHF], and arrhythmias). Main Results: Of 194 patients who underwent aortic abdominal surgery, carotid endarterectomy (CEA), or peripheral vascular surgery preceded by PTCA, 104 (54%) had a previous MI. Twenty-six patients (13.4%) had perioperative cardiac morbidity. Only one patient had an MI (0.5%; 95% confidence interval [CI], 0.0 to 2.8), whereas one patient died of CHF followed by multisystem organ failure (0.5%). The median interval between PTCA and surgery was 11 days (interquartile range, [IQR] 3 to 49 days). Patients who developed perioperative cardiac morbidity were older than those who did not (p = 0.02). Patients who had a history of CABG (before PTCA) had a higher incidence of postoperative angina (p = 0.04). The degree of preoperative LV dysfunction was linearly related to the incidence of new postoperative CHF (p = 0.01). Arrhythmias were more common in patients undergoing abdominal vascular surgery (17.9%) than in those undergoing CEA (2.5%; p = 0.03) or peripheral vascular surgery (5.2%; p = 0.02). Conclusion: High-risk cardiac patients undergoing vascular surgery who have had PTCA performed up to 18 months preoperatively have a low incidence of perioperative cardiac morbidity. Prophylactic PTCA may be beneficial in patients with CAD who are at high risk for perioperative cardiac complications.

Original languageEnglish (US)
Pages (from-to)501-506
Number of pages6
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume12
Issue number5
DOIs
StatePublished - Jan 1 1998
Externally publishedYes

Fingerprint

Coronary Balloon Angioplasty
Blood Vessels
Coronary Artery Disease
Morbidity
Coronary Artery Bypass
Heart Failure
Carotid Endarterectomy
Tertiary Care Centers
Cardiac Arrhythmias
Incidence
Left Ventricular Dysfunction
Left Ventricular Function

Keywords

  • Angina
  • Arrhythmia
  • Congestive heart failure
  • General anesthesia
  • Monitored anesthesia care
  • Myocardial infarction
  • Percutaneous transluminal coronary angioplasty
  • Regional anesthesia
  • Vascular surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty. / Gottlieb, Alexandru; Banoub, Mounir F; Sprung, Juraj; Levy, Pavel J.; Beven, Michael; Mascha, Edward J.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 12, No. 5, 01.01.1998, p. 501-506.

Research output: Contribution to journalArticle

Gottlieb, Alexandru ; Banoub, Mounir F ; Sprung, Juraj ; Levy, Pavel J. ; Beven, Michael ; Mascha, Edward J. / Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty. In: Journal of Cardiothoracic and Vascular Anesthesia. 1998 ; Vol. 12, No. 5. pp. 501-506.
@article{58d1e47685794946acb0c31f21652a46,
title = "Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty",
abstract = "Objective: Patients with coronary artery disease (CAD) who undergo noncardiac surgery are at increased risk for perioperative myocardial infarction (PMI). Undergoing successful coronary artery bypass grafting (CABG) before such surgery has been shown to decrease perioperative cardiac morbidity and mortality. Percutaneous transluminal coronary angioplasty (PTCA) is an alternative treatment for these patients. Perioperative cardiac morbidity in patients with CAD who underwent PTCA before their vascular surgery was reviewed. Setting: A tertiary care referral center for patients with cardiovascular heart disease. Participants: Review of vascular surgery database for patients who underwent vascular surgery preceded by PTCA between 1984 and 1995. Patients were excluded if they had a history of CABG within 2 years of surgery, had PTCA more than 18 months before surgery, or had incomplete data. Measurements: Data were collected concerning cardiac history, left ventricular (LV) function, perioperative cardiac morbidity (angina, MI, congestive heart failure [CHF], and arrhythmias). Main Results: Of 194 patients who underwent aortic abdominal surgery, carotid endarterectomy (CEA), or peripheral vascular surgery preceded by PTCA, 104 (54{\%}) had a previous MI. Twenty-six patients (13.4{\%}) had perioperative cardiac morbidity. Only one patient had an MI (0.5{\%}; 95{\%} confidence interval [CI], 0.0 to 2.8), whereas one patient died of CHF followed by multisystem organ failure (0.5{\%}). The median interval between PTCA and surgery was 11 days (interquartile range, [IQR] 3 to 49 days). Patients who developed perioperative cardiac morbidity were older than those who did not (p = 0.02). Patients who had a history of CABG (before PTCA) had a higher incidence of postoperative angina (p = 0.04). The degree of preoperative LV dysfunction was linearly related to the incidence of new postoperative CHF (p = 0.01). Arrhythmias were more common in patients undergoing abdominal vascular surgery (17.9{\%}) than in those undergoing CEA (2.5{\%}; p = 0.03) or peripheral vascular surgery (5.2{\%}; p = 0.02). Conclusion: High-risk cardiac patients undergoing vascular surgery who have had PTCA performed up to 18 months preoperatively have a low incidence of perioperative cardiac morbidity. Prophylactic PTCA may be beneficial in patients with CAD who are at high risk for perioperative cardiac complications.",
keywords = "Angina, Arrhythmia, Congestive heart failure, General anesthesia, Monitored anesthesia care, Myocardial infarction, Percutaneous transluminal coronary angioplasty, Regional anesthesia, Vascular surgery",
author = "Alexandru Gottlieb and Banoub, {Mounir F} and Juraj Sprung and Levy, {Pavel J.} and Michael Beven and Mascha, {Edward J.}",
year = "1998",
month = "1",
day = "1",
doi = "10.1016/S1053-0770(98)90090-8",
language = "English (US)",
volume = "12",
pages = "501--506",
journal = "Journal of Cardiothoracic and Vascular Anesthesia",
issn = "1053-0770",
publisher = "W.B. Saunders Ltd",
number = "5",

}

TY - JOUR

T1 - Perioperative cardiovascular morbidity in patients with coronary artery disease undergoing vascular surgery after percutaneous transluminal coronary angioplasty

AU - Gottlieb, Alexandru

AU - Banoub, Mounir F

AU - Sprung, Juraj

AU - Levy, Pavel J.

AU - Beven, Michael

AU - Mascha, Edward J.

PY - 1998/1/1

Y1 - 1998/1/1

N2 - Objective: Patients with coronary artery disease (CAD) who undergo noncardiac surgery are at increased risk for perioperative myocardial infarction (PMI). Undergoing successful coronary artery bypass grafting (CABG) before such surgery has been shown to decrease perioperative cardiac morbidity and mortality. Percutaneous transluminal coronary angioplasty (PTCA) is an alternative treatment for these patients. Perioperative cardiac morbidity in patients with CAD who underwent PTCA before their vascular surgery was reviewed. Setting: A tertiary care referral center for patients with cardiovascular heart disease. Participants: Review of vascular surgery database for patients who underwent vascular surgery preceded by PTCA between 1984 and 1995. Patients were excluded if they had a history of CABG within 2 years of surgery, had PTCA more than 18 months before surgery, or had incomplete data. Measurements: Data were collected concerning cardiac history, left ventricular (LV) function, perioperative cardiac morbidity (angina, MI, congestive heart failure [CHF], and arrhythmias). Main Results: Of 194 patients who underwent aortic abdominal surgery, carotid endarterectomy (CEA), or peripheral vascular surgery preceded by PTCA, 104 (54%) had a previous MI. Twenty-six patients (13.4%) had perioperative cardiac morbidity. Only one patient had an MI (0.5%; 95% confidence interval [CI], 0.0 to 2.8), whereas one patient died of CHF followed by multisystem organ failure (0.5%). The median interval between PTCA and surgery was 11 days (interquartile range, [IQR] 3 to 49 days). Patients who developed perioperative cardiac morbidity were older than those who did not (p = 0.02). Patients who had a history of CABG (before PTCA) had a higher incidence of postoperative angina (p = 0.04). The degree of preoperative LV dysfunction was linearly related to the incidence of new postoperative CHF (p = 0.01). Arrhythmias were more common in patients undergoing abdominal vascular surgery (17.9%) than in those undergoing CEA (2.5%; p = 0.03) or peripheral vascular surgery (5.2%; p = 0.02). Conclusion: High-risk cardiac patients undergoing vascular surgery who have had PTCA performed up to 18 months preoperatively have a low incidence of perioperative cardiac morbidity. Prophylactic PTCA may be beneficial in patients with CAD who are at high risk for perioperative cardiac complications.

AB - Objective: Patients with coronary artery disease (CAD) who undergo noncardiac surgery are at increased risk for perioperative myocardial infarction (PMI). Undergoing successful coronary artery bypass grafting (CABG) before such surgery has been shown to decrease perioperative cardiac morbidity and mortality. Percutaneous transluminal coronary angioplasty (PTCA) is an alternative treatment for these patients. Perioperative cardiac morbidity in patients with CAD who underwent PTCA before their vascular surgery was reviewed. Setting: A tertiary care referral center for patients with cardiovascular heart disease. Participants: Review of vascular surgery database for patients who underwent vascular surgery preceded by PTCA between 1984 and 1995. Patients were excluded if they had a history of CABG within 2 years of surgery, had PTCA more than 18 months before surgery, or had incomplete data. Measurements: Data were collected concerning cardiac history, left ventricular (LV) function, perioperative cardiac morbidity (angina, MI, congestive heart failure [CHF], and arrhythmias). Main Results: Of 194 patients who underwent aortic abdominal surgery, carotid endarterectomy (CEA), or peripheral vascular surgery preceded by PTCA, 104 (54%) had a previous MI. Twenty-six patients (13.4%) had perioperative cardiac morbidity. Only one patient had an MI (0.5%; 95% confidence interval [CI], 0.0 to 2.8), whereas one patient died of CHF followed by multisystem organ failure (0.5%). The median interval between PTCA and surgery was 11 days (interquartile range, [IQR] 3 to 49 days). Patients who developed perioperative cardiac morbidity were older than those who did not (p = 0.02). Patients who had a history of CABG (before PTCA) had a higher incidence of postoperative angina (p = 0.04). The degree of preoperative LV dysfunction was linearly related to the incidence of new postoperative CHF (p = 0.01). Arrhythmias were more common in patients undergoing abdominal vascular surgery (17.9%) than in those undergoing CEA (2.5%; p = 0.03) or peripheral vascular surgery (5.2%; p = 0.02). Conclusion: High-risk cardiac patients undergoing vascular surgery who have had PTCA performed up to 18 months preoperatively have a low incidence of perioperative cardiac morbidity. Prophylactic PTCA may be beneficial in patients with CAD who are at high risk for perioperative cardiac complications.

KW - Angina

KW - Arrhythmia

KW - Congestive heart failure

KW - General anesthesia

KW - Monitored anesthesia care

KW - Myocardial infarction

KW - Percutaneous transluminal coronary angioplasty

KW - Regional anesthesia

KW - Vascular surgery

UR - http://www.scopus.com/inward/record.url?scp=0031686530&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031686530&partnerID=8YFLogxK

U2 - 10.1016/S1053-0770(98)90090-8

DO - 10.1016/S1053-0770(98)90090-8

M3 - Article

C2 - 9801967

AN - SCOPUS:0031686530

VL - 12

SP - 501

EP - 506

JO - Journal of Cardiothoracic and Vascular Anesthesia

JF - Journal of Cardiothoracic and Vascular Anesthesia

SN - 1053-0770

IS - 5

ER -