Effect of preoperative angina pectoris on cardiac outcomes in patients with previous myocardial infarction undergoing major noncardiac surgery (data from ACS-NSQIP)

Ambarish Pandey, Akshay Sood, Jesse D. Sammon, Firas Abdollah, Ena Gupta, Harsh Golwala, Amit Bardia, Adam S. Kibel, Mani Menon, Quoc Dien Trinh

Research output: Contribution to journalArticle

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Abstract

The impact of preoperative stable angina pectoris on postoperative cardiovascular outcomes in patients with previous myocardial infarction (MI) who underwent major noncardiac surgery is not well studied. We studied patients with previous MI who underwent elective major noncardiac surgeries within the American College of Surgeons-National Surgical Quality Improvement Program (2005 to 2011). Primary outcome was occurrence of an adverse cardiac event (MI and/or cardiac arrest). Multivariable logistic regression models evaluated the impact of stable angina on outcomes. Of 1,568 patients (median age 70 years; 35% women) with previous MI who underwent major noncardiac surgery, 5.5% had postoperative MI and/or cardiac arrest. Patients with history of preoperative angina had significantly greater incidence of primary outcome compared to those without anginal symptoms (8.4% vs 5%, p = 0.035). In secondary outcomes, reintervention rates (22.5% vs 11%, p <0.001) and length of stay (median 6-days vs 5-days; p <0.001) were also higher in patients with preoperative angina. In multivariable analyses, preoperative angina was a significant predictor for postoperative MI (odds ratio 2.49 [1.20 to 5.58]) and reintervention (odds ratio 2.40 [1.44 to 3.82]). In conclusion, our study indicates that preoperative angina is an independent predictor for adverse outcomes in patients with previous MI who underwent major noncardiac surgery, and cautions against overreliance on predictive tools, for example, the Revised Cardiac Risk Index, in these patients, which does not treat stable angina and previous MI as independent risk factors during risk prognostication.

Original languageEnglish (US)
Pages (from-to)1080-1084
Number of pages5
JournalAmerican Journal of Cardiology
Volume115
Issue number8
DOIs
StatePublished - Jan 1 2015

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Angina Pectoris
Myocardial Infarction
Stable Angina
Heart Arrest
Logistic Models
Odds Ratio
Quality Improvement
Length of Stay
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Effect of preoperative angina pectoris on cardiac outcomes in patients with previous myocardial infarction undergoing major noncardiac surgery (data from ACS-NSQIP). / Pandey, Ambarish; Sood, Akshay; Sammon, Jesse D.; Abdollah, Firas; Gupta, Ena; Golwala, Harsh; Bardia, Amit; Kibel, Adam S.; Menon, Mani; Trinh, Quoc Dien.

In: American Journal of Cardiology, Vol. 115, No. 8, 01.01.2015, p. 1080-1084.

Research output: Contribution to journalArticle

Pandey, Ambarish ; Sood, Akshay ; Sammon, Jesse D. ; Abdollah, Firas ; Gupta, Ena ; Golwala, Harsh ; Bardia, Amit ; Kibel, Adam S. ; Menon, Mani ; Trinh, Quoc Dien. / Effect of preoperative angina pectoris on cardiac outcomes in patients with previous myocardial infarction undergoing major noncardiac surgery (data from ACS-NSQIP). In: American Journal of Cardiology. 2015 ; Vol. 115, No. 8. pp. 1080-1084.
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abstract = "The impact of preoperative stable angina pectoris on postoperative cardiovascular outcomes in patients with previous myocardial infarction (MI) who underwent major noncardiac surgery is not well studied. We studied patients with previous MI who underwent elective major noncardiac surgeries within the American College of Surgeons-National Surgical Quality Improvement Program (2005 to 2011). Primary outcome was occurrence of an adverse cardiac event (MI and/or cardiac arrest). Multivariable logistic regression models evaluated the impact of stable angina on outcomes. Of 1,568 patients (median age 70 years; 35{\%} women) with previous MI who underwent major noncardiac surgery, 5.5{\%} had postoperative MI and/or cardiac arrest. Patients with history of preoperative angina had significantly greater incidence of primary outcome compared to those without anginal symptoms (8.4{\%} vs 5{\%}, p = 0.035). In secondary outcomes, reintervention rates (22.5{\%} vs 11{\%}, p <0.001) and length of stay (median 6-days vs 5-days; p <0.001) were also higher in patients with preoperative angina. In multivariable analyses, preoperative angina was a significant predictor for postoperative MI (odds ratio 2.49 [1.20 to 5.58]) and reintervention (odds ratio 2.40 [1.44 to 3.82]). In conclusion, our study indicates that preoperative angina is an independent predictor for adverse outcomes in patients with previous MI who underwent major noncardiac surgery, and cautions against overreliance on predictive tools, for example, the Revised Cardiac Risk Index, in these patients, which does not treat stable angina and previous MI as independent risk factors during risk prognostication.",
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