Coronary angiography and failure to rescue after postoperative myocardial infarction in patients with coronary stents undergoing noncardiac surgery

Robert H. Hollis, Carla N. Holcomb, Javier A. Valle, Burke P. Smith, Aerin J. DeRussy, Laura A. Graham, Joshua S. Richman, Kamal M.F. Itani, Thomas M. Maddox, Mary T. Hawn

Research output: Contribution to journalArticle

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Abstract

Background We evaluated coronary angiography use among patients with coronary stents suffering postoperative myocardial infarction (MI) and the association with mortality. Methods Patients with prior coronary stenting who underwent inpatient noncardiac surgery in Veterans Affairs hospitals between 2000 and 2012 and experienced postoperative MI were identified. Predictors of 30-day post-MI mortality were evaluated. Results Following 12,096 operations, 353 (2.9%) patients had postoperative MI and 58 (16.4%) died. Post-MI coronary angiography was performed in 103 (29.2%) patients. Coronary angiography was not associated with 30-day mortality (odds ratio [OR]:.70, 95% CI:.35–1.42). Instead, 30-day mortality was predicted by revised cardiac risk index ≥3 (OR 1.91, 95% CI: 1.04–3.50) and prior bare metal stent (OR 2.12, 95% CI: 1.04–4.33). Conclusions Less than one-third of patients with coronary stents suffering postoperative MI underwent coronary angiography. Significant predictors of mortality were higher revised cardiac risk index and prior bare metal stent. These findings highlight the importance of comorbidities in predicting mortality following postoperative MI.

Original languageEnglish (US)
Pages (from-to)814-822.e1
JournalAmerican journal of surgery
Volume212
Issue number5
DOIs
StatePublished - Nov 1 2016
Externally publishedYes

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Coronary Angiography
Stents
Myocardial Infarction
Mortality
Odds Ratio
Metals
Veterans Hospitals
Comorbidity
Inpatients

Keywords

  • Cardiac risk index
  • Coronary angiography
  • Coronary stent
  • Failure to rescue
  • Postoperative mortality
  • Postoperative myocardial infarction

ASJC Scopus subject areas

  • Surgery

Cite this

Coronary angiography and failure to rescue after postoperative myocardial infarction in patients with coronary stents undergoing noncardiac surgery. / Hollis, Robert H.; Holcomb, Carla N.; Valle, Javier A.; Smith, Burke P.; DeRussy, Aerin J.; Graham, Laura A.; Richman, Joshua S.; Itani, Kamal M.F.; Maddox, Thomas M.; Hawn, Mary T.

In: American journal of surgery, Vol. 212, No. 5, 01.11.2016, p. 814-822.e1.

Research output: Contribution to journalArticle

Hollis, Robert H. ; Holcomb, Carla N. ; Valle, Javier A. ; Smith, Burke P. ; DeRussy, Aerin J. ; Graham, Laura A. ; Richman, Joshua S. ; Itani, Kamal M.F. ; Maddox, Thomas M. ; Hawn, Mary T. / Coronary angiography and failure to rescue after postoperative myocardial infarction in patients with coronary stents undergoing noncardiac surgery. In: American journal of surgery. 2016 ; Vol. 212, No. 5. pp. 814-822.e1.
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abstract = "Background We evaluated coronary angiography use among patients with coronary stents suffering postoperative myocardial infarction (MI) and the association with mortality. Methods Patients with prior coronary stenting who underwent inpatient noncardiac surgery in Veterans Affairs hospitals between 2000 and 2012 and experienced postoperative MI were identified. Predictors of 30-day post-MI mortality were evaluated. Results Following 12,096 operations, 353 (2.9{\%}) patients had postoperative MI and 58 (16.4{\%}) died. Post-MI coronary angiography was performed in 103 (29.2{\%}) patients. Coronary angiography was not associated with 30-day mortality (odds ratio [OR]:.70, 95{\%} CI:.35–1.42). Instead, 30-day mortality was predicted by revised cardiac risk index ≥3 (OR 1.91, 95{\%} CI: 1.04–3.50) and prior bare metal stent (OR 2.12, 95{\%} CI: 1.04–4.33). Conclusions Less than one-third of patients with coronary stents suffering postoperative MI underwent coronary angiography. Significant predictors of mortality were higher revised cardiac risk index and prior bare metal stent. These findings highlight the importance of comorbidities in predicting mortality following postoperative MI.",
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AU - DeRussy, Aerin J.

AU - Graham, Laura A.

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AB - Background We evaluated coronary angiography use among patients with coronary stents suffering postoperative myocardial infarction (MI) and the association with mortality. Methods Patients with prior coronary stenting who underwent inpatient noncardiac surgery in Veterans Affairs hospitals between 2000 and 2012 and experienced postoperative MI were identified. Predictors of 30-day post-MI mortality were evaluated. Results Following 12,096 operations, 353 (2.9%) patients had postoperative MI and 58 (16.4%) died. Post-MI coronary angiography was performed in 103 (29.2%) patients. Coronary angiography was not associated with 30-day mortality (odds ratio [OR]:.70, 95% CI:.35–1.42). Instead, 30-day mortality was predicted by revised cardiac risk index ≥3 (OR 1.91, 95% CI: 1.04–3.50) and prior bare metal stent (OR 2.12, 95% CI: 1.04–4.33). Conclusions Less than one-third of patients with coronary stents suffering postoperative MI underwent coronary angiography. Significant predictors of mortality were higher revised cardiac risk index and prior bare metal stent. These findings highlight the importance of comorbidities in predicting mortality following postoperative MI.

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