Key result
Pre-operative echocardiography was associated with a higher risk of post-operative MACE at 30 days (adjusted OR 1.92) among patients with coronary artery disease undergoing elective, non-cardiac surgery.
Why the study?
Does pre-operative echocardiography reduce post-operative MACE in patients with coronary artery disease undergoing elective non-cardiac surgery?
Cohort (n=26,641)
Yes
Does pre-operative echocardiography reduce post-operative MACE in patients with coronary artery disease undergoing elective non-cardiac surgery?
Odds Ratio: 1.92 (95% CI 1.66–2.23)
Absolute Event Rate: 7.5% vs 2.8%
p-value: p=<0.001
Pre-operative echocardiography prior to elective non-cardiac surgery in patients with coronary artery disease is not associated with a reduced risk of 30-day post-operative MACE, supporting guidelines against routine pre-surgical echocardiography.
May reflect confounding by indication; leaves open whether targeted echocardiography improves outcomes in CAD non-cardiac surgery.
BACKGROUND: Echocardiography is not recommended for routine pre-surgical evaluation but may have value for patients at high risk of major adverse cardiovascular events (MACE). The objective of this study was to evaluate whether pre-operative echocardiography is associated with lower risk of post-operative MACE among patients with coronary artery disease. METHODS: Using administrative and registry data, we examined associations of echocardiography within 3 months prior to surgery with postoperative MACE (myocardial infarction, revascularization, or death within 30 days) among patients with coronary artery disease undergoing elective, non-cardiac surgeries in the United States Veterans Affairs healthcare system in 2000-2012. RESULTS: Echocardiography preceded 4,378 (16.4 %) of 26,641 surgeries. MACE occurred within 30 days following 944 (3.5 %) surgeries. A 10 % higher case-mix adjusted rate of pre-operative echocardiography assessed at the hospital level was associated with a hospital-level risk of MACE that was 1.0 % (95 % confidence interval [CI] 0.1 %, 2.0 %) higher overall and 1.7 % (95 % CI 0.2 %, 3.2 %) higher among patients with recent myocardial infarction, valvular heart disease, or heart failure. At the patient level, pre-operative echocardiography was associated with an odds ratio for MACE of 1.9 (95 % CI 1.7, 2.2) overall and 1.8 (95 % CI 1.5, 2.2) among patients with recent myocardial infarction, valvular heart disease, or heart failure adjusting for MACE risk factors. CONCLUSIONS: Pre-operative echocardiography was not associated with lower risk of post-operative MACE, even in a high risk population. Future guidelines should encourage pre-operative echocardiography only in specific patients with cardiovascular disease among whom findings can be translated into effective changes in care.
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Levitan et al. (2016) conducted a cohort in Coronary artery disease undergoing elective, non-cardiac surgeries (n=26,641). Pre-operative echocardiography vs. No pre-operative echocardiography was evaluated on Major adverse cardiac events (MACE) within 30 days post-surgery (OR 1.92, 95% CI 1.66-2.23, p=<0.001). Pre-operative echocardiography was associated with a higher risk of post-operative MACE at 30 days (adjusted OR 1.92) among patients with coronary artery disease undergoing elective, non-cardiac surgery.
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