CARDIAC RISK OF NONCARDIAC SURGERY - INFLUENCE OF CORONARY-DISEASE AND TYPE OF SURGERY IN 3368 OPERATIONS

Background The influence of prior coronary artery bypass surgery (CABG ) versus medical therapy for reducing the risk of postoperative cardia c complications after noncardiac surgery continues to be debated. To f urther clarify this controversy we studied 24 959 participants in the Coronary Artery Surgery Study (CASS) database with suspected coronary disease by identifying those who required noncardiac surgery during mo re than 10 years of follow-up. Methods and Results CASS registry enrol lees were either treated with CABG or medical therapy after initial en try. During follow-up, patients who required noncardiac operations wer e evaluated for hospital death or out-of-hospital death within 30 days of noncardiac surgery and nonfatal postoperative myocardial infarctio n (MI). At a mean follow-up of 4.1 years, 3368 patients underwent nonc ardiac surgery, with abdominal (36%), urologic (21%), orthopedic (15%) , and vascular being most common. Abdominal, vascular, thoracic, and h ead and neck surgery each had a combined MI/death rate among patients with nonrevascularized coronary disease >4%. Among 1961 patients under going higher-risk surgery, prior CABG was associated with fewer postop erative deaths (1.7% versus 3.3%, P=.03) and MIs (0.8% versus 2.7%, P= .002) compared with medically managed coronary disease. Contrariwise, 1297 patients undergoing urologic, orthopedic, breast, and skin operat ions had mortality of <1% regardless of prior coronary treatment. Prio r CABG was most protective in patients with advanced angina and/or mul tivessel coronary artery disease. Conclusions In patients with known c oronary artery disease, noncardiac surgeries involving the thorax, abd omen, vasculature, and head and neck are associated with the highest c ardiac risk, which is reduced among patients with prior CABG.