Abstract 12254: Perioperative Mortality and Myocardial Injury Among Patients With Prior High-Risk Cardiac Events Undergoing Non-Cardiac Surgery: A VISON Substudy
Background: Recent high-risk coronary artery disease (CAD) (i.e.,myocardial infarction (MI), class III/IV angina) within 6 months of non-cardiac surgery (NCS) is associated with increased mortality and myocardial injury after NCS (MINS). Guidelines recommend waiting at least 4-6 weeks before NCS; however, the evidence is limited.
Hypothesis: Delaying NCS at least 2 months after high-risk CAD would reduce 30-day mortality and MINS rates.
Methods: We assessed 1 versus 2-6 month NCS delay-times after high-risk CAD on 30-day outcomes by performing multivariable regression analyses on patients, ≥45 years who underwent NCS and were in the VISION Study, an international prospective cohort study of a representative sample of patients undergoing NCS.
Results: Among 16,066 patients, 190 patients had recent high-risk CAD (134 had an MI and 56 had class III/IV angina). In patients without recent high-risk CAD, the 30-day mortality rate was 1.9% and the 30-day MINS rate was 7.9%, whereas patients with a recent high-risk cardiac event had a 30-day mortality rate of 10% (aHR 3.12; 95% CI,1.94-5.00; p<0.001) and a 30-day MINS rate of 31.8% (aHR 1.63; 95% CI,1.21-2.19; p=0.001). Compared to patients without recent high-risk CAD, patients having NCS within 1 month of a high-risk CAD event had a mortality rate of 10.2% (aHR 3.08; 95% CI,1.63-5.83; p<0.001) and patients who had NCS within 2-6 months had a mortality rate of 9.8% (aHR 3.16; 95% CI,1.61-6.18 ; p<0.001); (p=0.96 for comparison between <1 month versus 2-6 months). Surgery within 1 and 2-6 months of high-risk CAD was associated with a 30-day MINS rate of 38.4% (aHR 1.76; 95% CI, 1.22-2.53; p=0.003) and 25.0% (aHR 1.47; 95%CI, 0.94-2.30; p=0.093), respectively, compared to patients without recent high-risk CAD; p= 0.53 for the comparison between <1 month versus 2-6 months.
Conclusions: In patients with prior high-risk cardiac events, waiting 1 versus 2-6 months did not significantly reduce 30-day mortality or the risk of MINS.
Author Disclosures: S. Thomas: None. I. Garutti: None. P. Alonso: None. D. Heels-Ansdell: None. P. Cruz: None. C. Fernandez-Riveira: None. P. Piñeiro: None. L.G. Glance: None. P.J. Devereaux: Research Grant; Significant; Abbott, Astra-Zeneca, Bayer, Boerhinger Ingelheim, Bristol-Myers Squibb, Covidien, Roche Diagnostics, Stryker.
- © 2014 by American Heart Association, Inc.