PERIOPERATIVE CARDIOVASCULAR MORBIDITY IN PATIENTS WITH CORONARY-ARTERY DISEASE UNDERGOING VASCULAR-SURGERY AFTER PERCUTANEOUS TRANSLUMINALCORONARY ANGIOPLASTY

Objective: Patients with coronary artery disease (CAD) who undergo non cardiac surgery are at increased risk for perioperative myocardial inf arction (PMI). Undergoing successful coronary artery bypass grafting ( CABG) before such surgery has been shown to decrease perioperative car diac morbidity and mortality Percutaneous transluminal coronary angiop lasty (PTCA) is an alternative treatment for these patients. Periopera tive cardiac morbidity in patients with CAD who underwent PTCA before their vascular surgery was reviewed. Setting: A tertiary care referral center for patients with cardiovascular heart disease. Participants: Review of vascular surgery database for patients who underwent vascula r surgery preceded by PTCA between 1984 and 1995. Patients were exclud ed if they had a history of CABG within 2 years of surgery, had PTCA m ore than 18 months before surgery, or had incomplete data. Measurement s: Data were collected concerning cardiac history, left ventricular (L V) function, perioperative cardiac morbidity (angina, MI, congestive h eart failure [CHF], and arrhythmias). Main Results:Of 194 patients who underwent aortic abdominal surgery, carotid endarterectomy (CEA), or peripheral vascular surgery preceded by PTCA, 104 (54%) had a previous MI. Twenty-six patients (13.4%) had perioperative cardiac morbidity. Only one patient had an MI (0.5%; 95% confidence interval [CI], 0.0 to 2.8), whereas one patient died of CHF followed by multisystem organ f ailure (0.5%). The median interval between PTCA and surgery was 11 day s (interquartile range, [IQR] 3 to 49 days). Patients who developed pe rioperative cardiac morbidity were older than those who did not (p = 0 .02). Patients who had a history of CABG (before PICA) had a higher in cidence of postoperative angina (p = 0.04). The degree of preoperative LV dysfunction was linearly related to the incidence of new postopera tive CHF (p = 0.01). Arrhythmias were more common in patients undergoi ng abdominal vascular surgery (17.9%) than in those undergoing CEA (2. 5%; p = 0.03) or peripheral vascular surgery (5.2%; p = 0.02). Conclus ion: High-risk cardiac patients undergoing vascular surgery who have h ad PTCA performed up to 18 months preoperatively have a low incidence of perioperative cardiac morbidity. Prophylactic PTCA may be beneficia l in patients with CAD who are at high risk for perioperative cardiac complications. Copyright (C) 1998 by W.B. Saunders Company.