Open AccessNoncardiac Surgery in Patients With Aortic Stenosis: A Contemporary Study on Outcomes in a Matched Sample From the Danish Health Care System
Author(s) -
Andersson Charlotte,
Jørgensen Mads Emil,
Martinsson Andreas,
Hansen Peter Wæde,
Gustav Smith J.,
Jensen Per Føge,
Gislason Gunnar H.,
Køber Lars,
TorpPedersen Christian
Publication year - 2014
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22324
Subject(s) - medicine , mace , perioperative , myocardial infarction , heart failure , stroke (engine) , stenosis , cohort , risk factor , adverse effect , danish , cardiology , surgery , hazard ratio , cohort study , confidence interval , percutaneous coronary intervention , mechanical engineering , linguistics , philosophy , engineering
Background Past research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30‐day major adverse cardiovascular event (MACE) and all‐cause mortality were investigated in a contemporary Danish cohort. Hypothesis AS is not an independent risk factor for adverse outcomes in noncardiac surgery. Methods All patients with and without diagnosed AS who underwent noncardiac surgery in 2005 to 2011 were identified through nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type. Results In elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death) occurred in 66/1772 (3.7%) of patients with AS and 52/1772 (2.9%) of controls ( P = 0.19), whereas mortality occurred in 67/1772 (3.8%) AS patients and 51/1772 (2.9%) controls ( P = 0.13). In emergency surgery, 163/1051 (15.5%) AS patients and 120/1051 (11.4%) controls had a MACE ( P = 0.006), whereas 225/1051 (21.4%) vs 179/1051 (17.0%) AS patients and controls died, respectively ( P = 0.01). Event rates were higher for those with symptoms (defined as use of nitrates, congestive heart failure, or use of loop diuretics), compared with those without symptoms ( P < 0.0001). Conclusions AS is associated with high perioperative rates of MACE and mortality, but perhaps prognosis is, in practice, not much worse for patients with AS than for matched controls. Symptomatic patients and patients undergoing emergency surgery are at considerable risks of a MACE and mortality.