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Operative procedures not involving the heart after percutaneous transluminal coronary angioplasty
J R Allen1, T S Helling, G O Hartzler
1Department of Surgery, University of Missouri-Kansas City School of Medicine.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is safe for subsequent non-cardiac surgery, protecting against fatal cardiac events. However, older patients (>60) face higher risks for nonfatal cardiac complications post-PTCA.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) is established for coronary artery disease (CAD) patients needing non-cardiac surgery.
- Percutaneous transluminal coronary angioplasty (PTCA) emerged as an alternative to CABG for CAD treatment.
Purpose of the Study:
- To evaluate the safety of non-cardiac surgical procedures following PTCA in patients with CAD.
- To assess cardiac morbidity and mortality risks in patients undergoing non-cardiac surgery after PTCA.
Main Methods:
- Retrospective review of 148 patients undergoing 193 non-cardiac surgical procedures.
- Procedures were performed between 4 and 1,867 days after PTCA for CAD.
- Analysis included patient demographics, CAD severity, timing of surgery relative to PTCA, and postoperative cardiac outcomes.
Main Results:
- Overall postoperative mortality was low (4 deaths), with only one cardiac-related death (myocardial infarction).
- Patients operated on within 90 days of PTCA showed no increased cardiac morbidity, though the single myocardial infarction occurred in this group.
- Older patients (>60 years) experienced significantly more cardiac complications (16/110) compared to younger patients (0/38).
Conclusions:
- PTCA treatment for CAD provides myocardial protection against fatal cardiac events and myocardial infarction during subsequent non-cardiac surgery, even early post-procedure.
- Patients undergoing non-cardiac surgery after PTCA have a favorable safety profile regarding major adverse cardiac events.
- Older patients (>60) represent a higher-risk group for nonfatal cardiac complications following non-cardiac surgery in the post-PTCA period.
Abstract:
The benefit of coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) who require extensive surgical procedures not involving the heart has been established. During the past decade, percutaneous transluminal coronary angioplasty (PTCA) has been developed as an alternative therapy to CABG for patients with CAD. In an attempt to determine the safety of other surgical procedures after PTCA, we retrospectively reviewed 148 patients who underwent 193 surgical procedures from four to 1,867 days after PTCA for CAD. Seventy-two patients had surgical treatment within 90 days of PTCA. Thirty-five patients had CABG prior to PTCA, and 113 had PTCA as the initial treatment for CAD. Four patients died postoperatively, only one death was cardiac in origin. One patient had a myocardial infarction postoperatively (the one cardiac death). Fifteen patients had other cardiac complications (nine patients with arrhythmias and six with myocardial ischemia). Patients operated upon within 90 days of PTCA had no increased cardiac morbidity, although the one myocardial infarction occurred in this group. No difference in cardiac morbidity occurred in patients with multivessel CAD treated by PTCA compared with single vessel disease. However, patients more than 60 years of age had more cardiac problems (16 of 110) than those less than 60 years of age (zero of 38) (p = 0.01). Treatment of CAD by PTCA protects the myocardium from fatal cardiac events and myocardial infarction during subsequent noncardiac operative procedures even early (less than 90 days) in the post-PTCA period. Older patients seem to be at higher risk, however, for nonfatal cardiac complications.