Adverse cardiac outcomes after noncardiac surgery in patients with prior percutaneous transluminal coronary angioplasty

In this retrospective cohort study, we compared adverse cardiac outcomes af ter noncardiac surgery among patients with prior percutaneous transluminal coronary angioplasty (PTCA), patients with nonrevascularized coronary arter y disease (CAD), and normal controls. Inpatient hospital discharge abstract s from all nonfederal acute care hospitals in Washington State linked to de ath certificates were evaluated. Patients greater than or equal to 45 yr ol d with prior PTCA who underwent noncardiac surgery from 1987 to 1993 were m atched by age, sex, surgery type, and discharge year to 686 patients with C AD and to 2155 normal controls (no CAD). We compared risk for adverse cardi ac outcomes (death, myocardial infarction, angina, congestive heart failure , malignant dysrhythmia, cardiogenic shock, coronary artery bypass graft, o r PTCA) within 30 days. Patients with PTCA had twice the risk of adverse ca rdiac outcome as normal controls (odds ratio [OR] 1.98; P < 0.001), with a higher risk of angina (OR 7.84), congestive heart failure (OR 2.06), and my ocardial infarction (OR 3.86) but a lower risk of death (OR 0.46; P < 0.001 ). Patients with PTCA had half the risk of adverse cardiac outcome as patie nts with CAD (OR 0.50; P < 0.001), including less risk of angina (OR 0.51) and congestive heart failure (OR 0.40; P < 0.001), but no difference in myo cardial infarction (P = 0.304) or death (P = 0.436). No difference was foun d between 142 patients with recent PTCA (less than or equal to 90 days befo re noncardiac surgery) matched to patients with CAD (OR 0.90; P = 0.396). P atients revascularized by PTCA >90 days before noncardiac surgery seem to h ave a lower risk of poor outcome than nonrevascularized patients, although not as low as normal controls. For recent PTCA patients, the lack of differ ence compared with CAD patient outcomes requires a larger sample size for v erification. Present findings do not lend support to a role for prophylacti c PTCA to improve noncardiac surgery outcomes. This investigation did not c ontrol for CAD severity, medical management, or comorbidities. Study of the se factors is needed before the clinical implications of PTCA for noncardia c surgical risk can be completely assessed. Implications: Hospital records showed patients with prior percutaneous transluminal coronary angioplasty w ere twice as likely as healthy patients to have an adverse cardiac outcome after noncardiac surgery, although their risk was reduced by half compared with patients with untreated coronary artery disease. Further study of the role of percutaneous transluminal coronary angioplasty in modulating noncar diac surgery risk is needed.