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. 2014 May 12;3(3):e000388.
doi: 10.1161/JAHA.113.000388.

The epidemiology and outcomes of percutaneous coronary intervention before high-risk noncardiac surgery in contemporary practice: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry

Palaniappan Muthappan  1 , Dean Smith, Herbert D Aronow, Kim Eagle, David Wohns, James Fox, David Share, Hitinder S Gurm
Affiliations

The epidemiology and outcomes of percutaneous coronary intervention before high-risk noncardiac surgery in contemporary practice: insights from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) Registry

Palaniappan Muthappan et al. J Am Heart Assoc. .

Abstract

Background: Percutaneous coronary intervention (PCI) is sometimes performed with the intent to lower cardiovascular risk before high-risk noncardiac surgery (HRNCS). There are limited data on the frequency and outcome of PCIs performed in this setting.

Methods and results: We assessed the frequency, characteristics, and in-hospital outcomes of patients undergoing PCI as part of the preoperative workup for HRNCS among all 61 145 elective PCIs performed between 2002 and 2009 at 14 hospitals in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium. Propensity matching was performed to compare outcomes of patients undergoing PCI before HRNCS with all other elective PCI patients. The frequency of PCI before HRNCS was low (4.2%). Patients undergoing PCI before HRNCS were older (67.3 versus 64.9 years, P<0.0001) and had a greater burden of comorbidity. Patients undergoing PCI before HRNCS had an increase in unadjusted major adverse cardiovascular events, postprocedure transfusion, contrast-induced nephropathy, nephropathy requiring dialysis, and same-admission coronary artery bypass graft surgery, but there was no difference in mortality (0.27% versus 0.14%, P=0.11). However, in propensity score-matched samples, there was a significant difference only in nephropathy requiring dialysis.

Conclusions: The incidence of PCI performed in preparation for high-risk noncardiac surgery is low, and these procedures are currently being performed on a highly selected high-risk patient population.

Keywords: angioplasty; epidemiology; preoperative revascularization; stents.

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Figures

Figure 1.
Figure 1.
PCIs done in preparation for high‐risk noncardiac surgery (HRNCS) as a percentage of total elective PCIs in the BMC2 cohort, 2002–2009. BMC2 indicates Blue Cross Blue Shield of Michigan Cardiovascular Consortium; PCI, percutaneous coronary intervention.
Figure 2.
Figure 2.
Hospital variation in pre‐HRNCS PCIs as a percentage of total elective PCIs. BMC2 indicates Blue Cross Blue Shield of Michigan Cardiovascular Consortium; HRNCS, high‐risk noncardiac surgery; PCI, percutaneous coronary intervention.
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