Pre-operative echocardiography among patients with coronary artery disease in the United States Veterans Affairs healthcare system: A retrospective cohort study.
Echocardiography is not recommended for routine pre-surgical evaluation but may have value for patients at high risk of major adverse cardiovascular events (MACE). The objective of this study was to evaluate whether pre-operative echocardiography is associated with lower risk of post-operative MACE among patients with coronary artery disease.



Using administrative and registry data, we examined associations of echocardiography within 3 months prior to surgery with postoperative MACE (myocardial infarction, revascularization, or death within 30 days) among patients with coronary artery disease undergoing elective, non-cardiac surgeries in the United States Veterans Affairs healthcare system in 2000-2012.



Echocardiography preceded 4,378 (16.4 %) of 26,641 surgeries. MACE occurred within 30 days following 944 (3.5 %) surgeries. A 10 % higher case-mix adjusted rate of pre-operative echocardiography assessed at the hospital level was associated with a hospital-level risk of MACE that was 1.0 % (95 % confidence interval [CI] 0.1 %, 2.0 %) higher overall and 1.7 % (95 % CI 0.2 %, 3.2 %) higher among patients with recent myocardial infarction, valvular heart disease, or heart failure. At the patient level, pre-operative echocardiography was associated with an odds ratio for MACE of 1.9 (95 % CI 1.7, 2.2) overall and 1.8 (95 % CI 1.5, 2.2) among patients with recent myocardial infarction, valvular heart disease, or heart failure adjusting for MACE risk factors.



Pre-operative echocardiography was not associated with lower risk of post-operative MACE, even in a high risk population. Future guidelines should encourage pre-operative echocardiography only in specific patients with cardiovascular disease among whom findings can be translated into effective changes in care.
Department of Epidemiology, University of Alabama at Birmingham, 35294-0022, Birmingham, AL, USA. elevitan@uab.edu.|Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA. elevitan@uab.edu.
Emily B
EB
Levitan
Department of Epidemiology, University of Alabama at Birmingham, 35294-0022, Birmingham, AL, USA.|Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
Laura A
LA
Graham
Division of Cardiology, University of Colorado, Denver, CO, USA.
Javier A
JA
Valle
Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.|Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Joshua S
JS
Richman
Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.|Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Robert
R
Hollis
Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.|Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Carla N
CN
Holcomb
Division of Cardiology, University of Colorado, Denver, CO, USA.|Veterans Affairs Eastern Colorado Health Care System, Denver, CO, USA.
Thomas M
TM
Maddox
Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.|Department of Surgery, Stanford University, Stanford, CA, USA.
Mary T
MT
Hawn
D000368:Aged; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011300:Preoperative Care / Q000379:methods*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans
Echocardiography; Major adverse cardiac events; Surgery