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Perioperative cardiovascular outcome in patients with coronary artery disease undergoing major vascular surgery: A

Diana Thomas1, S Sharmila1, M S Saravana Babu1

  • 1Division of Cardiothoracic and Vascular Anesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.

Annals of Cardiac Anaesthesia
|July 8, 2022
PubMed

Insights

Major adverse cardiac events (MACE) in patients with coronary artery disease (CAD) undergoing aortic surgery are frequent and deadly. Preoperative optimization is key to reducing MACE risk.

Area of Science:

  • Cardiology
  • Vascular Surgery
  • Anesthesiology

Background:

  • Major adverse cardiac events (MACE) significantly contribute to morbidity and mortality in patients undergoing major vascular surgeries.
  • Coronary artery disease (CAD) is a critical comorbidity in patients undergoing aortic surgeries.
  • Assessing MACE incidence, risk factors, and outcomes in CAD patients undergoing aortic surgery is crucial.

Purpose of the Study:

  • To evaluate the incidence of MACE in patients with CAD undergoing aortic surgeries.
  • To identify risk factors associated with MACE in this patient population.
  • To determine the outcomes of MACE in patients undergoing aortic surgery.

Main Methods:

  • Retrospective observational study of 141 patients with CAD undergoing elective major vascular aortic surgeries from 2010-2019.
  • Analysis of preoperative risk factors including revised cardiac risk index, functional status, CAD severity, and treatment.
  • Evaluation of anesthesia techniques, including general anesthesia with or without epidural analgesia.

Main Results:

  • Perioperative MACE incidence was 11.3% (16/141), with an overall in-hospital mortality of 6.4% (9/141), all MACE-related.
  • Patients who underwent preoperative coronary revascularization had a higher odds of MACE (OR: 3.9; 95% CI, 1.34-11.34).
  • Epidural analgesia added to general anesthesia did not reduce perioperative MACE.

Conclusions:

  • Major vascular surgeries in CAD patients are high-risk procedures with significant mortality associated with perioperative MACE.
  • Early detection and medical optimization of CAD are vital for mitigating MACE risk.
  • Risk stratification and tailored preoperative management are essential for improving outcomes.
Abstract

Keywords:
Coronary artery diseasemajor vascular surgeriesperioperative MACE

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