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Utilization efficacy of noninvasive and invasive cardiac testing among stable cardiac patients undergoing noncardiac
Constantine A Hassapoyannes1, Dan-Victor Giurgiutiu, Alexander Bagasra
1Section of Cardiology, Medical Service, WJB Dorn Veterans Affairs Medical Center, Columbia, SC, USA.
Insights
Coronary angiography reduced cardiac mortality in stable cardiac patients undergoing intermediate-to-high-risk noncardiac surgery. This procedure is not recommended for low-risk surgeries.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Medicine
Background:
- Patients with coronary artery disease face elevated risks during noncardiac surgery.
- This study investigated the utility of coronary angiography in identifying and treating ischemic heart disease in cardiac patients undergoing noncardiac procedures.
- The hypothesis posited no difference in cardiac complications between patients who underwent coronary angiography and those who did not.
Purpose of the Study:
- To determine if coronary angiography is effectively used to identify and treat ischemic heart disease in cardiac patients undergoing noncardiac surgery.
- To compare cardiac complications and mortality between patients who underwent coronary angiography and those who did not.
- To assess the impact of coronary angiography on cardiac outcomes in patients with stable cardiac disease undergoing noncardiac surgery.
Main Methods:
- A secondary analysis of a prospective cohort study involving 314 patients with stable cardiac disease undergoing elective noncardiac surgery.
- Patients were stratified based on their history of coronary arteriography.
- Follow-up extended for at least 30 days postoperatively or until discharge.
Main Results:
- 37.9% of patients had a coronary angiogram a median of 19 months prior to surgery.
- Cardiac deaths occurred in 4.8% of patients, primarily those with congestive heart failure and/or diabetes.
- Despite higher clinical risk, the coronary angiography group showed similar cardiac morbidity but significantly lower cardiac mortality (0.8% vs. 7.2%) compared to the non-angiography group.
Conclusions:
- Coronary arteriography is linked to reduced mortality in stable cardiac patients undergoing intermediate-to-high-risk noncardiac surgery.
- The procedure is deemed unwarranted for low-risk noncardiac procedures.
- Increased risk associated with diabetes and congestive heart failure suggests potential underutilization of noninvasive testing and coronary angiography in these patient subgroups.
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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