Pre-operative echocardiography among patients with coronary artery disease in the United States Veterans Affairs healthcare system: A retrospective cohort study

摘要

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.