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Does Previous Coronary Angiography Influence Complications in Total Joint Arthroplasty, and Should the Surgery Be
Amir Human Hoveidaei1, Kasra Pirahesh2, Mohammad Poursalehian3
1International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland.
Insights
A history of coronary angiography (CAG) before total joint arthroplasty (TJA) increases risks for myocardial infarction (MI) and cerebrovascular accident (CVA). Delaying TJA may reduce other complications, especially for patients with stents.
Area of Science:
- Orthopedic Surgery
- Cardiology
- Public Health
Background:
- Cardiovascular diseases are prevalent in patients undergoing total joint arthroplasty (TJA).
- Many TJA candidates have prior coronary angiography (CAG), a procedure assessing heart arteries.
- The impact of prior CAG on TJA postoperative outcomes requires investigation.
Purpose of the Study:
- To evaluate if a history of CAG increases postoperative complications after total hip (THA) and total knee arthroplasty (TKA).
- To determine how the timing of CAG relative to TJA influences complication rates.
- To assess specific risks such as myocardial infarction (MI), cerebrovascular accident (CVA), and others.
Main Methods:
- Analysis of a national database for THA and TKA patients (2012-2020).
- Grouping patients based on CAG history (with/without stent) and timing intervals (0-36 months).
- Utilizing propensity score-matching and multivariate logistic regression to compare outcomes.
Main Results:
- Prior CAG was associated with higher rates of MI, CVA, and blood transfusion in both TKA and THA patients.
- Elevated MI and CVA risks persisted regardless of CAG-to-arthroplasty timing.
- Other complications like acute renal failure and VTE decreased with delays beyond 12 months, except in stented patients.
- Prosthetic joint infection and revision rates were similar across groups.
Conclusions:
- A history of CAG, particularly with stent placement, is a significant risk factor for postoperative complications after TJA.
- MI and CVA risks remain elevated irrespective of the timing of arthroplasty after CAG.
- Consider strategic delays in TJA for patients with prior CAG to mitigate potential complications.
Background:
Cardiovascular diseases are common in total joint arthroplasty (TJA) patients, many of whom undergo coronary angiography (CAG) before total hip (THA) or knee (TKA) arthroplasty. This study evaluated whether a history of CAG increases postoperative complications and how its timing affects outcomes.
Methods:
Using a national database, we analyzed patients undergoing THA or TKA between 2012 and 2020. Patients were grouped by CAG history (with and without stent placement) and timing intervals (within six, six to 12, 12 to 18, 18 to 24, and 24 to 36 months). Outcomes included readmission, myocardial infarction (MI), cerebrovascular accident (CVA), venous thromboembolism (VTE), surgical site infection, prosthetic joint infection (PJI), acute renal failure (ARF), revision surgery, and blood transfusion. Analysis used propensity score-matching and multivariate logistic regression.
Results:
Patients who underwent TKA with prior CAG (n = 4,602 with stent; n = 25,514 without stent) had significantly higher rates of MI, CVA, and blood transfusion compared to controls. These risks remained elevated across all CAG-to-TKA intervals. Acute renal failure, VTE, and readmission were significantly increased in earlier time intervals, but generally normalized with delays beyond 12 months, except in the stented subgroup, where elevated risks persisted up to 18 months. No significant differences were observed in 2-years PJI or revision rates. Patients who had a THA and a prior CAG (n = 3,422 with stent; n = 14,728 without stent) also experienced higher rates of MI, CVA, and blood transfusions. These risks did not decline with longer CAG-to-THA intervals. Readmission, VTE, and ARF were elevated in early time intervals, but normalized with delays beyond 12 months. Both PJI and revision rates were similar between groups.
Conclusions:
A history of CAG, especially with stent placement, is linked to higher postoperative complications, with MI and CVA risks remaining elevated regardless of surgery timing in both THA and TKA groups. Strategic TJA delay for other complications is recommended for patients with prior CAG undergoing arthroplasty.
Level Of Evidence:
III.
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