Does preoperative coronary angioplasty improve perioperative cardiac outcome?
BACKGROUND
Percutaneous coronary intervention (PCI) is performed in patients with coronary artery disease who are undergoing major noncardiac procedures to reduce perioperative cardiac morbidity and mortality. However, the impact of this approach on postoperative outcome remains controversial.


METHODS
The authors analyzed a cohort of 1,152 patients after abdominal aortic surgery in which 78 patients underwent PCI. A propensity score analysis was performed. Also, using a logistic regression model, the authors determined variables associated with a severe postoperative coronary event or a death in patients without PCI. Then, in patients with PCI, they compared the expected and observed outcome.


RESULTS
Five variables (age > 75 yr, blood transfusion > 3 units, repeated surgery, preoperative hemodialysis, and previous cardiac failure) independently predicted (with 94% correctly classified) a severe postoperative coronary event, and five variables (age > 75 yr, repeated surgery, previously abnormal ST segment/T waves, previous hypertension, and previous cardiac failure) independently predicted (with 97% correctly classified) postoperative death. In the PCI group, the observed percentages of patients with a severe postoperative coronary event (9.0% [95% confidence interval, 4.4-17.4]) or death (5.1% [95% confidence interval, 2.0-12.5]) were not significantly different from the expected percentages (8.2 and 6.9%, respectively). When all patients were pooled together, the odds ratios of PCI were not significant. The propensity score analysis provided a similar conclusion.


CONCLUSIONS
PCI did not seem to limit significantly cardiac risk or death after aortic surgery.
Godet
Gilles
G
Anesthesiology and Critical Care, Hospitalo-Universitaire Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75651 Paris cedex 13, France. gilles.godet@psl.ap-hop-paris.fr
Riou
Bruno
B
Bertrand
Michèle
M
Fléron
Marie-Hélène
MH
Goarin
Jean-Pierre
JP
Montalescot
Gilles
G
Coriat
Pierre
P
D000368:Aged; D000465:Algorithms; D000758:Anesthesia; D000800:Angioplasty, Balloon; D006348:Cardiac Surgical Procedures; D009202:Cardiomyopathies / Q000453:epidemiology / Q000209:etiology; D003643:Death; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015233:Models, Statistical; D010147:Pain Measurement / Q000187:drug effects; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D020379:Risk Adjustment; D018401:Sample Size; D016896:Treatment Outcome