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Pre-operative echocardiography among patients with coronary artery disease in the United States Veterans Affairs healthcare system: A retrospective cohort study
- Source :
- BMC Cardiovascular Disorders
- Publication Year :
- 2016
- Publisher :
- Springer Science and Business Media LLC, 2016.
-
Abstract
- 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. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0357-5) contains supplementary material, which is available to authorized users.
- Subjects :
- Male
medicine.medical_specialty
Population
Coronary Artery Disease
Risk Assessment
01 natural sciences
Coronary artery disease
010104 statistics & probability
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Preoperative Care
Myocardial Revascularization
medicine
Humans
Registries
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
0101 mathematics
Major adverse cardiac events
education
Veterans Affairs
Aged
Retrospective Studies
Veterans
education.field_of_study
business.industry
Incidence
valvular heart disease
Middle Aged
medicine.disease
United States
Cardiac surgery
United States Department of Veterans Affairs
Echocardiography
Heart failure
Cardiology
Female
Surgery
Cardiology and Cardiovascular Medicine
business
Mace
Follow-Up Studies
Research Article
Subjects
Details
- ISSN :
- 14712261
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- BMC Cardiovascular Disorders
- Accession number :
- edsair.doi.dedup.....c563937b892ae46d76ea090cbd0e9217