Incomplete Revascularization: Increased Events Rate in Non-Cardiac Surgery?

The aim of this study was to determine whether incomplete revascularization is associated to higher adverse events risk and acute myocardial infarction in patients undergoing non-cardiac surgery.

Coronary artery disease patients or patients with prior PCI often have non cardiac surgery. These patients may have had all obstructions treated before surgery (complete revascularization) or only a few (incomplete revascularization).

Incomplete revascularization was defined as any ≥50% residual stenosis in the left main, or ≥70% residual stenosis in any epicardial coronary artery based on visual estimate.

A total of 4,332 patients (34.7%) arrived to non-cardiac surgery with incomplete revascularization; there were 567 major adverse events within the first month after surgery.

Patients with incomplete revascularization showed a 19% increase in post-operative events risk, compared to those with complete revascularization.

Among end point components, perioperative MI contributed with most events, and was 37% more frequent in the incomplete revascularization group.

After variable adjusting, there was significant interaction between the moment of PCI and events, after non cardiac surgery. Incomplete revascularization was associated with significant increased risk of perioperative MI when surgery was done within 6 weeks of PCI (odds ratio: 1.84; CI 95%: 1.04 to 2.38).

The number of vessels with incomplete revascularization was also associated with increased risk of perioperative MI; for each vessel with incomplete revascularization, MI risk increases 17%.

Conclusion

Incomplete revascularization in patients with coronary artery disease was associated to an increased risk in MI after non-cardiac surgery.

Original Title: Incomplete Revascularization Is Associated with an Increased Risk for Major Adverse Cardiovascular Events Among Patients Undergoing Noncardiac Surgery.

Reference: Ehrin J. Armstrong et al. JACC Cardiovasc Interv. 2017 Feb 27;10(4):329-338.

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