title: Coronary revascularization and adverse events in joint arthroplasty.
abstract: BACKGROUND
  There is a paucity of literature about outcome of total joint arthroplasty in patients with the history of angioplasty and/or stent or coronary artery bypass graft (CABG). The present study aimed to evaluate perioperative complications and mortality in these patients.
  
  
  METHODS
  We used the Nationwide Inpatient Sample data from 2002-2011. Using the Ninth Revision of the International Classification of Disease, Clinical Modification codes for disorders and procedures, we identified patients with a history of coronary revascularization (angioplasty and/or stent or CABG) and compared the inhospital adverse events in these patients with patients without a history of coronary revascularization.
  
  
  RESULTS
  Cardiac complications occurred in 1.06% patients with a history of CABG; 0.95% of patients with a coronary angioplasty and/or stent and 0.82% of the control patients. In the multivariate analysis, neither the history of CABG (P = 0.07) nor the history of angioplasty and/or stenting (P = 0.86) was associated with a higher risk of cardiac complications. However, myocardial infarction occurred in a significantly higher proportion of patients with the history of CABG (0.66%, odds ratio, 1.24, P = 0.001) and coronary angioplasty and/or stenting (0.67%, odds ratio, 1.96, P < 0.001) compared with that in the controls (0.27%). History of coronary revascularization did not increase the risk of respiratory, renal, and wound complications, surgical site infection, and mortality.
  
  
  CONCLUSIONS
  Based on the findings of this study, it appears that there is no increased risk of inhospital mortality and complications (except for myocardial infarction) in patients with a history of coronary artery revascularization undergoing total joint arthroplasty. We also found perioperative cardiac arrhythmia, particularly atrial fibrillation, to be an independent predictor of inhospital adverse events.
authors.affiliation: Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Reza Mostafavi
authors.initials: RM
authors.lastname: Tabatabaee
authors.affiliation: Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
authors.affiliation: Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Maryam
authors.initials: M
authors.lastname: Rezapoor
authors.affiliation: Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mitchell G
authors.initials: MG
authors.lastname: Maltenfort
authors.affiliation: Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Alvin C
authors.initials: AC
authors.lastname: Ong
authors.affiliation: Rothman Institute of Orthopaedics, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address: parvj@aol.com.
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D001178:Arthroplasty; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000401:mortality; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D054556:Venous Thromboembolism / Q000209:etiology
keywords: Adverse events; Coronary angioplasty/stent; Coronary artery bypass graft; Mortality; Nationwide Inpatient Sample; Total joint arthroplasty