Non-Cardiac Surgery with Incomplete Revascularization, Associated to Events

This study presented at the American Heart Association Scientific Sessions 2016 and simultaneously published in the Journal of the American College of Cardiology, showed incomplete revascularization is associated with an increased risk of adverse cardiac events, particularly infarction, in patients that must later receive non-cardiac surgery.

Patients with incomplete revascularization (defined as a ≥ 50% left main lesion or a ≥ 70% lesion in any major epicardial vessel) have a 19% higher risk of events at 30 days when facing non-cardiac surgery vs. patients with complete revascularization (p=0.05).

The difference was basically driven by a 37% increase in infarction risk (p=0.01). For each unrevascularized vessel, perioperative infarction risk increased 17% (p<0.001).

The study included 12,486 patients undergoing PCI and subsequent non-cardiac surgery. Of these patients, 35% arrived to the OR with incomplete revascularization.

Prior evidence is from the CARP study (Coronary Artery Revascularization Prophylaxis), which included 5,859 patients with prior revascularization surgery programed to receive non-cardiac surgery.

In the CARP study, revascularization did not change long term events rate, which led to minimizing revascularization prior to surgery. However, the CARP study was published ten years ago.

In this new study, researchers have found out a significant interaction with the time of non-cardiac surgery. Patients undergoing non cardiac surgery 6 weeks before PCI with incomplete revascularization had 84% more perioperatory risk compared to those with complete revascularization operated within the same timeframe.

Risk was no higher in those operated beyond 6 weeks after PCI.

One of the limitations to this study is that it was not possible to determine the type of post operatory MI. They could have been caused by either troponin elevation, plaque rupture or stent thrombosis.

Original Title: Incomplete revascularization is associated with an increased risk of major adverse cardiovascular events among patients undergoing non-cardiac surgery.

Presenter:  Armstrong EJ.

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