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Canadian Journal of Anesthesia

, 54:705 | Cite as

The effects of prophylactic coronary revascularization or medical management on patient outcomes after noncardiac surgery - a meta-analysis

  • Elise Y. W. Wong
  • Herenia P. Lawrence
  • David T. Wong
Reports of Original Investigations

Abstract

Purpose

The benefits of prophylactic coronary revascularization for patients undergoing noncardiac surgery are uncertain. The purpose of this study was to systematically evaluate the effect of coronary revascularization and medical management on short- and long-term outcomes after noncardiac surgery.

Method

Ten electronic databases including Medline and embase (1980 to February 2006), and bibliographies of included articles were searched without language restrictions. Studies comparing effects of coronary revascularization and medical management before noncardiac surgery were included. Patient outcome data including perioperative mortality, myocardial infarction, long-term mortality, or late adverse cardiac events were extracted and entered into a meta-analysis.

Results

The quality of published evidence was modest, comprising one randomized controlled trial and six retrospective studies. A total of 3,949 patients undergoing high-risk noncardiac surgery were included in the quantitative analysis. There was no significant difference between coronary revascularization and medical management groups with regards to postoperative mortality and myocardial infarction; the odds ratios (95% confidence. intervals) were 0.85 (0.48-1.50) and 0.95 (0.44-2.08), respectively. There were no long-term outcome benefits associated with prophylactic coronary revascularization; the odds ratios (95% confidence intervals) were 0.81 (0.40-1.63) and 1.65 (0.70-3.86) for long-term mortality and late adverse cardiac events, respectively.

Conclusion

In patients with stable coronary artery disease, prophylactic coronary revascularization before high-risk noncardiac surgery does not confer any beneficial effects, when compared with optimized medical management, in terms of perioperative mortality, myocardial infarction, long-term mortality, or adverse cardiac events.

Keywords

Abdominal Aortic Aneurysm Coronary Revascularization Critical Appraisal Skill Program Medical Management Group Prophylactic Coronary Revascularization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Les effets de la revascularisation coronarienne prophylactique ou de la prise en charge médicale sur le devenir des patients après une chirurgie non-cardiaque: une méta-analyse

Résumé

Objectif

Les bienfaits de la revascularisation coronarienne prophylactique chez les patients subissant une chirurgie non cardiaque sont mal connus. L’objectif de cette étude était d’évaluer de façon systématique l’effet d’une revascularisation coronarienne et de la prise en charge médicale sur le devenir des patients après une chirurgie non cardiaque, à court et à long terme.

Méthode

Dix bases de données électroniques, y compris MEDLINE et EMBASE (1980 à février 2006), ainsi que les bibliographies des articles inclus, ont fait l’objet d’une recherche sans restriction de langue. Les études comparant les effets de la revascularisation coronarienne et de la prise en charge médicale avant une chirurgie non cardiaque ont été inclus dans la recherche. Les données concernant le devenir des patients, y compris la mortalité périopératoire, les infarctus du myocarde, la mortalité à long terme, et les événements cardiaques négatifs tardifs ont été extraites des études et analysées dans une méta-analyse.

Résultats

La qualité des données probantes publiées a été modeste, comprenant une étude randomisée contrôlée et six études rétrospectives. Au total, 3949 patients subissant une chirurgie non cardiaque à haut risque ont été inclus dans l’analyse quantitative. Il n’y a pas eu de différence significative entre le groupe de revascularisation coronarienne et celui de prise en charge médicale quant à la mortalité postopératoire et à l’infarctus du myocarde; les rapports de cotes (intervalles de confiance de 95 %) étaient de 0,85 (0,48-1,50) et de 0,95 (0,44-2,08), respectivement. Aucun bienfait sur le devenir à long terme n’a été associé à la revascularisation coronarienne prophylactique; les rapports de cotes (intervalles de confiance de 95 %) étaient de 0,81 (0,40-1,63) et 1,65 (0,70-3,86) pour la mortalité à long terme et les effets cardiaques négatifs tardifs, respectivement.

Conclusion

Chez les patients avec une maladie coronarienne stable, la revascularisation coronarienne prophylactique avant une chirurgie non cardiaque à haut risque n’offre pas d’effets bénéfiques par rapport à une prise en charge médicale optimisée, en termes de mortalité périopératoire, d’infarctus du myocarde, de mortalité à long terme ou d’évènements cardiaques négatifs.

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Copyright information

© Canadian Anesthesiologists 2007

Authors and Affiliations

  • Elise Y. W. Wong
    • 1
  • Herenia P. Lawrence
    • 2
  • David T. Wong
    • 4
    • 3
  1. 1.Departments of Dental AnesthesiaToronto Western Hospital, University of TorontoTorontoCanada
  2. 2.Departments of Biological and Diagnostic SciencesToronto Western Hospital, University of TorontoTorontoCanada
  3. 3.Departments of AnesthesiaToronto Western Hospital, University of TorontoTorontoCanada
  4. 4.Department of AnesthesiologyMC 2-405, Toronto Western HospitalTorontoCanada

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