Utilization efficacy of noninvasive and invasive cardiac testing among stable cardiac patients undergoing noncardiac surgery

Constantine A. Hassapoyannes, Dan-Victor Giurgiutiu, Alexander Bagasra, Mohammad Reza Movahed

Research output: Contribution to journalArticle

Abstract

Background: Patients with coronary artery disease are at increased risk from noncardiac surgery. We examined a population of cardiac patients undergoing noncardiac surgery to determine whether coronary angiography was successfully utilized to identify and treat ischemic heart disease. Our hypothesis was that cardiac complications would not differ between the group of patients who underwent coronary angiography and the group that did not. Methods: We conducted a secondary analysis from a prospective, cohort study of 314 patients with stable cardiac disease undergoing elective noncardiac surgery. The cohort was stratified by history of coronary arteriography. Follow-up extended postoperatively for a minimum of 30 days or until discharge if later. Results: Of this cohort, 37.9% of the patients had a coronary angiogram at a median interval of 19 months (range, 1 day-13 years) before surgery. Among the 15 cardiac deaths (4.8%), 14 patients had compensated congestive heart failure and/or diabetes. The two arms were similar by surgical risk. Despite a higher clinical risk (P<.001), the catheterized vs. noncatheterized arm exhibited a similar cardiac morbidity and a lower cardiac mortality (0.8% vs. 7.2%, P=.01). The lower cardiac mortality persisted whether the patients were recently or remotely catheterized and whether revascularized or not. Conclusion: Coronary arteriography is associated with mortality risk-reduction among stable cardiac patients undergoing intermediate-to-high-risk noncardiac surgery, but is unwarranted for low-risk procedures. A higher risk linked to diabetes and congestive heart failure suggests underutilization of noninvasive testing and coronary arteriography among patients with these diagnoses and stable cardiac disease.

Original languageEnglish (US)
Pages (from-to)12-18
Number of pages7
JournalCardiovascular Revascularization Medicine
Volume7
Issue number1
DOIs
StatePublished - Jan 1 2006
Externally publishedYes

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Angiography
Coronary Angiography
Mortality
Heart Diseases
Heart Failure
Risk Reduction Behavior
Myocardial Ischemia
Coronary Artery Disease
Cohort Studies
Prospective Studies
Morbidity
Population

Keywords

  • Coronary angiography
  • Heart disease
  • Preoperative care
  • Surgical procedures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Utilization efficacy of noninvasive and invasive cardiac testing among stable cardiac patients undergoing noncardiac surgery. / Hassapoyannes, Constantine A.; Giurgiutiu, Dan-Victor; Bagasra, Alexander; Movahed, Mohammad Reza.

In: Cardiovascular Revascularization Medicine, Vol. 7, No. 1, 01.01.2006, p. 12-18.

Research output: Contribution to journalArticle

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abstract = "Background: Patients with coronary artery disease are at increased risk from noncardiac surgery. We examined a population of cardiac patients undergoing noncardiac surgery to determine whether coronary angiography was successfully utilized to identify and treat ischemic heart disease. Our hypothesis was that cardiac complications would not differ between the group of patients who underwent coronary angiography and the group that did not. Methods: We conducted a secondary analysis from a prospective, cohort study of 314 patients with stable cardiac disease undergoing elective noncardiac surgery. The cohort was stratified by history of coronary arteriography. Follow-up extended postoperatively for a minimum of 30 days or until discharge if later. Results: Of this cohort, 37.9{\%} of the patients had a coronary angiogram at a median interval of 19 months (range, 1 day-13 years) before surgery. Among the 15 cardiac deaths (4.8{\%}), 14 patients had compensated congestive heart failure and/or diabetes. The two arms were similar by surgical risk. Despite a higher clinical risk (P<.001), the catheterized vs. noncatheterized arm exhibited a similar cardiac morbidity and a lower cardiac mortality (0.8{\%} vs. 7.2{\%}, P=.01). The lower cardiac mortality persisted whether the patients were recently or remotely catheterized and whether revascularized or not. Conclusion: Coronary arteriography is associated with mortality risk-reduction among stable cardiac patients undergoing intermediate-to-high-risk noncardiac surgery, but is unwarranted for low-risk procedures. A higher risk linked to diabetes and congestive heart failure suggests underutilization of noninvasive testing and coronary arteriography among patients with these diagnoses and stable cardiac disease.",
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AB - Background: Patients with coronary artery disease are at increased risk from noncardiac surgery. We examined a population of cardiac patients undergoing noncardiac surgery to determine whether coronary angiography was successfully utilized to identify and treat ischemic heart disease. Our hypothesis was that cardiac complications would not differ between the group of patients who underwent coronary angiography and the group that did not. Methods: We conducted a secondary analysis from a prospective, cohort study of 314 patients with stable cardiac disease undergoing elective noncardiac surgery. The cohort was stratified by history of coronary arteriography. Follow-up extended postoperatively for a minimum of 30 days or until discharge if later. Results: Of this cohort, 37.9% of the patients had a coronary angiogram at a median interval of 19 months (range, 1 day-13 years) before surgery. Among the 15 cardiac deaths (4.8%), 14 patients had compensated congestive heart failure and/or diabetes. The two arms were similar by surgical risk. Despite a higher clinical risk (P<.001), the catheterized vs. noncatheterized arm exhibited a similar cardiac morbidity and a lower cardiac mortality (0.8% vs. 7.2%, P=.01). The lower cardiac mortality persisted whether the patients were recently or remotely catheterized and whether revascularized or not. Conclusion: Coronary arteriography is associated with mortality risk-reduction among stable cardiac patients undergoing intermediate-to-high-risk noncardiac surgery, but is unwarranted for low-risk procedures. A higher risk linked to diabetes and congestive heart failure suggests underutilization of noninvasive testing and coronary arteriography among patients with these diagnoses and stable cardiac disease.

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