Cardiac Catheterization Before Noncardiac Surgery

Study Questions:

What are the characteristics, angiographic findings, and treatment patterns of clinically stable patients undergoing cardiac catheterization and/or percutaneous coronary intervention (PCI) before noncardiac surgery?

Methods:

This study is a retrospective, descriptive analysis of the National Cardiovascular Data Registry CathPCI Registry diagnostic catheterization and PCI data from July 1, 2009, through December 31, 2014. Data analysis was performed from April 21, 2015, to January 4, 2016. The study included 194,444 patients from 1,046 sites who underwent coronary angiography before noncardiac surgery. Patients with acute coronary syndrome, cardiogenic shock, cardiac arrest, or emergency catheterization were excluded. Demographic characteristics, preprocedure noninvasive testing results, angiographic findings, and treatment recommendations were summarized. Among the 27,838 patients who underwent PCI, procedural details, inpatient outcomes, and discharge medications were reported.

Results:

Of the 194,444 included patients, 113,590 (58.4%) were male, the median age was 65 years (interquartile range, 57-73 years), and 162,532 (83.6%) were white. Most were overweight or obese (152,849 [78.6%]), and 78,847 (40.6%) had diabetes mellitus. Most patients were asymptomatic (117,821 [60.6%]), although 112,302 (57.8%) had been taking antianginal medications within 2 weeks of the procedure. Prior noninvasive stress testing was reported in 126,766 (65.2%), and results were positive in 109,458 (86.3%) of those with stress data. Obstructive disease was present in 93,447 (48.1%). After diagnostic angiography, revascularization with PCI or bypass surgery was recommended in 46,380 patients (23.8%) in the overall cohort, 27,191 asymptomatic patients (23.1%), and 45,083 patients with obstructive disease (48.3%). In the 27,191 patients undergoing PCI, 367 treated lesions (1.3%) were in the left main artery and 3,831 (13.8%) in the proximal left anterior descending artery. A total of 11,366 patients (40.8%) received drug-eluting stents. Complications occurred in a few patients, with a catheterization-related mortality rate of 0.05%.

Conclusions:

The authors concluded that most patients undergoing diagnostic catheterization before noncardiac surgery are asymptomatic.

Perspective:

This descriptive registry study reports that most patients referred for catheterization before noncardiac surgery are asymptomatic, but they are commonly found to have obstructive coronary artery disease (CAD). It appears that nearly one half of those with obstructive CAD undergo revascularization, while the other half are treated medically. These data highlight the variability in treatment patterns and the need for a better evidence-based approach to patients undergoing noncardiac surgery.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Angiography, Cardiac Catheterization, CathPCI Registry, Coronary Angiography, Coronary Artery Bypass, Coronary Artery Disease, Diabetes Mellitus, Diagnostic Imaging, Drug-Eluting Stents, Myocardial Revascularization, Overweight, Percutaneous Coronary Intervention, Secondary Prevention, Stents, Surgical Procedures, Operative


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