Abstract 19577: Incomplete Revascularization is Associated With an Increased Risk of Postoperative Myocardial Infarction Among Patients Undergoing Noncardiac Surgery
Background: Major adverse cardiac events remain a major source of morbidity after noncardiac surgery in patients with CAD. The impact of a complete revascularization strategy on MACE in these patients is unknown.
Methods: We identified patients undergoing noncardiac surgeries within 2 years after PCI in VA hospitals from 2004-2012 and divided the cohort into patients with complete vs. incomplete revascularization. Incomplete revascularization was defined as a residual stenosis of ≥50% in the LMCA or ≥70% in another major epicardial coronary artery after PCI. We compared the association between incomplete revascularization and postoperative MACE (mortality, MI, revascularization), using multivariate logistic regression to adjust for demographic, clinical and procedural variables.
Results: 12,486 patients underwent noncardiac surgery within 2 years following PCI. Within the cohort, 4,332 (34.7%) patients had incomplete revascularization, and 567 had postoperative MACE. Patients with incomplete revascularization had a 5.0% rate of MACE, while those with complete revascularization had a rate of 4.3% (p=0.05). After multivariate adjustment, odds of MACE were not statistically significantly different between groups, however the odds of postoperative MI were significantly higher in patients with incomplete revascularization (OR 1.37, 95% CI 1.10-1.70; Figure 1a). Additionally, there was a significant interaction between time from PCI and postoperative MACE, with incomplete revascularization associated with an increased risk of postoperative MI if surgery was performed within six weeks after PCI (OR 1.84, 95% CI 1.04-2.38 Figure 1b). Finally, for patients with incomplete revascularization, each unrevascularized vessel increased the odds of postoperative MI by 17%.
Conclusions: Incomplete revascularization is associated with an increased risk of postoperative MI, especially if revascularization is performed within 6 weeks of surgery.
- Percutaneous coronary intervention (PCI)
- Myocardial revascularization
- Myocardial infarction
Author Disclosures: J.A. Valle: None. E.J. Armstrong: Other Research Support; Modest; Cardiovascular Systems, Inc. Consultant/Advisory Board; Modest; Abbott Vascular, Medtronic, Spectranetics. L. Graham: None. S.W. Waldo: Research Grant; Modest; Merck. T.M. Maddox: None. M.T. Hawn: None.
- © 2016 by American Heart Association, Inc.