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[Noncardiac surgery in patients with ischemic heart disease]
Y Shimoyama1, Y Wanibuchi, E Hata
1Department of Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Insights
Patients with suspected ischemic heart disease (IHD) face significantly higher cardiac complication risks during non-cardiac surgery. Coronary angiography (CAG) and prior revascularization, like bypass surgery, may reduce these risks.
Area of Science:
- Cardiology
- Anesthesiology
- Vascular Surgery
Background:
- Patients undergoing non-cardiac surgery with suspected ischemic heart disease (IHD) present a heightened risk for cardiac complications.
- Pre-operative cardiac evaluation is crucial for stratifying surgical risk in this population.
Purpose of the Study:
- To assess the incidence of fatal or life-threatening cardiac complications in patients with suspected IHD undergoing non-cardiac surgery.
- To evaluate the impact of pre-operative coronary angiography (CAG) and revascularization procedures (coronary bypass grafting [CABG] or percutaneous transluminal angioplasty [PTCA]) on cardiac outcomes.
Main Methods:
- Retrospective analysis of 4679 patients operated under general anesthesia between January 1983 and December 1988.
- Comparison of cardiac complication rates between patients with and without suspected IHD.
- Subgroup analysis of IHD patients based on pre-operative CAG and prior revascularization (CABG/PTCA).
Main Results:
- The incidence of cardiac complications was significantly higher in IHD patients (5.0%) compared to non-IHD patients (0.03%).
- IHD patients who had not undergone CAG prior to non-cardiac operations had a higher complication rate (13.8%) than those who had received CAG.
- IHD patients with a history of CABG or PTCA experienced a markedly lower complication rate (one event).
Conclusions:
- Coronary angiography (CAG) should be more actively considered for patients with suspected IHD undergoing non-cardiac surgery.
- Prior revascularization (CABG or PTCA) appears to decrease cardiac complications in IHD patients.
- Careful peri-operative management remains essential for all IHD patients undergoing non-cardiac procedures.
Abstract:
From January 1983 to December 1988, 4679 patients with operated under general anesthesia in our institute: 161 patients involved suspected ischemic heart disease (IHD patients) by history or electrocardiogram. Eight of 161 patients (5.0%) experienced fatal or life-threatening cardiac complications. On the other hand, only two non-IHD patients (0.03%) experienced complications. IHD patients had a significantly higher incidence of complications compared with non-IHD patients. Forty-five IHD patients had not undergone coronary cineangiogram (CAG) before noncardiac operations and six of them (13.8%) experienced complications. They had a significantly higher incidence of complications compared with other IHD-patients who had received CAG. Fifty-five IHD patients who had already been treated by coronary bypass grafting (CABG) or by percutaneous transluminal angioplasty experienced only one complication. We conclude that CAG should be more actively performed for IHD patients because prior CABG or PTCA is suspected to decrease cardiac complications in IHD patients. However, IHD patients must be managed as carefully as possible.