A meta-analysis of the prospective randomised trials of coronary revascularisation before noncardiac vascular surgery with attention to the type of coronary revascularisation performed.
Prospective randomised trials of coronary revascularisation prior to noncardiac surgery have shown no survival benefit following noncardiac surgery. However, these studies have not differentiated the outcomes associated with coronary artery bypass grafting (CABG) and percutaneous coronary interventions. We performed a meta-analysis of the randomised controlled trials of pre-operative coronary revascularisation for noncardiac surgery, extracting data for 30 day and long term all-cause mortality and myocardial infarction (MI) following revascularisation, according to the type of revascularisation performed. Pre-operative percutaneous coronary intervention was associated with significantly increased 30 day MI and composite death and MI. Pre-operative CABG was associated with a significantly improved long term composite outcome of death and MI compared to percutaneous coronary interventions. The adverse effect of percutaneous coronary interventions on both short and long term outcomes in vascular surgical patients should be taken into consideration when interpreting these trials. CABG may improve long term outcomes in vascular surgical patients. The indications for and timing of CABG in vascular surgical patients needs further research.
Biccard
B M
BM
Department of Anaesthetics, Nelson R Mandela School of Medicine, Private Bag 7, Congella 4013, South Africa. biccardb@ukzn.ac.za
Rodseth
R N
RN
D000368:Aged; D001026:Coronary Artery Bypass; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009204:Myocardial Revascularization / Q000009:adverse effects / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality