title: Coronary angiography and failure to rescue after postoperative myocardial infarction in patients with coronary stents undergoing noncardiac surgery.
abstract: BACKGROUND
  We evaluated coronary angiography use among patients with coronary stents suffering postoperative myocardial infarction (MI) and the association with mortality.
  
  
  METHODS
  Patients with prior coronary stenting who underwent inpatient noncardiac surgery in Veterans Affairs hospitals between 2000 and 2012 and experienced postoperative MI were identified. Predictors of 30-day post-MI mortality were evaluated.
  
  
  RESULTS
  Following 12,096 operations, 353 (2.9%) patients had postoperative MI and 58 (16.4%) died. Post-MI coronary angiography was performed in 103 (29.2%) patients. Coronary angiography was not associated with 30-day mortality (odds ratio [OR]: .70, 95% CI: .35-1.42). Instead, 30-day mortality was predicted by revised cardiac risk index ≥3 (OR 1.91, 95% CI: 1.04-3.50) and prior bare metal stent (OR 2.12, 95% CI: 1.04-4.33).
  
  
  CONCLUSIONS
  Less than one-third of patients with coronary stents suffering postoperative MI underwent coronary angiography. Significant predictors of mortality were higher revised cardiac risk index and prior bare metal stent. These findings highlight the importance of comorbidities in predicting mortality following postoperative MI.
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Department of Surgery, Birmingham Veterans Administration Hospital, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hollis
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Department of Surgery, Birmingham Veterans Administration Hospital, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Carla N
authors.initials: CN
authors.lastname: Holcomb
authors.affiliation: Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Javier A
authors.initials: JA
authors.lastname: Valle
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Department of Surgery, Birmingham Veterans Administration Hospital, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Burke P
authors.initials: BP
authors.lastname: Smith
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Department of Surgery, Birmingham Veterans Administration Hospital, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Aerin J
authors.initials: AJ
authors.lastname: DeRussy
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Department of Surgery, Birmingham Veterans Administration Hospital, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Graham
authors.affiliation: Center for Surgical, Medical Acute Care Research and Transitions (C-SMART), Department of Surgery, Birmingham Veterans Administration Hospital, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Richman
authors.affiliation: Department of Surgery, VA Boston Health Care System, Boston University and Harvard Medical School, Boston, MA, USA.
authors.forename: Kamal M F
authors.initials: KM
authors.lastname: Itani
authors.affiliation: Department of Medicine, VA Eastern Colorado Health Care System, Denver, CO, USA; Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Department of Surgery, VA Palo Alto Health Care System, Stanford University, Palo Alto, CA, USA. Electronic address: mhawn@stanford.edu.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Hawn
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D016017:Odds Ratio; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure
keywords: Cardiac risk index; Coronary angiography; Coronary stent; Failure to rescue; Postoperative mortality; Postoperative myocardial infarction