Cardiac events after noncardiac surgery in patients with or without coronary artery stenosis based on angiography

Objective The perioperative cardiac risk associated with non-cardiac surgery in patients with significant coronary artery stenosis has not been fully determined. This study aimed to assess cardiac events after non-cardiac surgery in patients with or without coronary artery stenosis (CAS) based on pre-operative coronary angiography. Methods This single-center, observational study retrospectively analyzed data from 809 patients without a history of percutaneous coronary intervention or coronary artery bypass grafting who underwent coronary angiography before non-cardiac surgery for risk assessment. After excluding 94 patients who underwent preoperative coronary revascularization, 715 (215 with CAS and 500 without CAS) were assessed. The occurrence of cardiac events, including cardiac death, non-fatal myocardial infarction, the requirement for urgent revascularization, worsening heart failure, worsening angina symptoms, and ventricular tachycardia/fibrillation within 30 days of surgery, was investigated. Results The mean age of the patients was 70.3±9.7 years, and 72.7% were men. Patients with CAS were more likely to be men and had diabetes mellitus and dyslipidemia compared to those without CAS. Regarding perioperative cardiac risk, 401 (56.1%) non-cardiac surgical procedures were categorized as having a high cardiac risk, 248 (34.7%) as intermediate, and 66 (9.2%) as low. Within 30 days of non-cardiac surgery, no significant difference was observed in the occurrence of cardiac events between the patients with and without CAS (1.9% vs. 1.4%, p=0.74). Conclusion The findings suggest that significant CAS is not necessarily associated with an increased perioperative risk of cardiac events.