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THE EPIDEMIOLOGY AND OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION BEFORE HIGH RISK NON-CARDIAC SURGERY: INSIGHTS FROM THE BMC2 REGISTRY
E339 JACC March 27, 2012 Volume 59, Issue 13
ACC-i2 with TCT THE EPIDEMIOLOGY AND OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION BEFORE HIGH RISK NON-CARDIAC SURGERY: INSIGHTS FROM THE BMC2 REGISTRY i2 Oral Contributions McCormick Place South, S103b Sunday, March 25, 2012, Noon-12:10 p.m.
Session Title: Outcomes in Patients Treated with PCI Abstract Category: 4. Outcomes/Operator Volume/Public Reporting/Misc. Topics/Guidelines Presentation Number: 2511-15 Authors: Palaniappan Muthappan, Dean Smith, Herbert Aronow, Kim Eagle, David Wohns, James Fox, David Share, Hitinder Gurm, University of Michigan Cardiovascular Center, Ann Arbor, MI, USA Background: Percutaneous coronary intervention (PCI) is sometimes performed in hopes of lowering cardiovascular risk prior to high risk noncardiac surgery (HRNCS). There are limited data on the frequency, characteristics and outcome of these patients. Methods: We assessed the frequency and in-hospital outcomes of PCI performed during the preoperative work up for HRNCS among 57,508 patients with stable coronary disease between 2005 and 2009 at 33 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Propensity matching was used to compare outcomes in patients undergoing PCI prior to HRNCS with all other patients undergoing PCI for stable coronary disease. Results: The frequency of PCI prior to HRNCS was low (3.9%) and declined over the study period (figure 1). Patients undergoing PCI prior to HRNCS were older and had more comorbidity. In unadjusted analyses, there was no difference in in-hospital mortality, but an increase in myocardial infarction (MI), transfusion and nephropathy requiring dialysis (NRD) was observed. However, in propensity matched models, there was no difference in any major adverse outcome (death 0.23 v. 0.38%, p=0.44; MI 2.38 v. 1.77%, p=0.27; transfusion 2.08 v. 2.54%, p=0.42; NRD 0.17 v. 0.08%, p=0.56). Conclusion: PCI is performed infrequently prior to HRNCS and the incidence declined over the study period. PCI performed prior to HRNCS is associated with worse outcomes, but these differences are explained by older age and more frequent comorbidity.
ACC-i2 with TCT THE EPIDEMIOLOGY AND OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION BEFORE HIGH RISK NON-CARDIAC SURGERY: INSIGHTS FROM THE BMC2 REGISTRY i2 Oral Contributions McCormick Place South, S103b Sunday, March 25, 2012, Noon-12:10 p.m.
Session Title: Outcomes in Patients Treated with PCI Abstract Category: 4. Outcomes/Operator Volume/Public Reporting/Misc. Topics/Guidelines Presentation Number: 2511-15 Authors: Palaniappan Muthappan, Dean Smith, Herbert Aronow, Kim Eagle, David Wohns, James Fox, David Share, Hitinder Gurm, University of Michigan Cardiovascular Center, Ann Arbor, MI, USA Background: Percutaneous coronary intervention (PCI) is sometimes performed in hopes of lowering cardiovascular risk prior to high risk noncardiac surgery (HRNCS). There are limited data on the frequency, characteristics and outcome of these patients. Methods: We assessed the frequency and in-hospital outcomes of PCI performed during the preoperative work up for HRNCS among 57,508 patients with stable coronary disease between 2005 and 2009 at 33 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). Propensity matching was used to compare outcomes in patients undergoing PCI prior to HRNCS with all other patients undergoing PCI for stable coronary disease. Results: The frequency of PCI prior to HRNCS was low (3.9%) and declined over the study period (figure 1). Patients undergoing PCI prior to HRNCS were older and had more comorbidity. In unadjusted analyses, there was no difference in in-hospital mortality, but an increase in myocardial infarction (MI), transfusion and nephropathy requiring dialysis (NRD) was observed. However, in propensity matched models, there was no difference in any major adverse outcome (death 0.23 v. 0.38%, p=0.44; MI 2.38 v. 1.77%, p=0.27; transfusion 2.08 v. 2.54%, p=0.42; NRD 0.17 v. 0.08%, p=0.56). Conclusion: PCI is performed infrequently prior to HRNCS and the incidence declined over the study period. PCI performed prior to HRNCS is associated with worse outcomes, but these differences are explained by older age and more frequent comorbidity.