Potential of coronary angiography in the assessment of cardiac complication risk during non-cardiac interventions
Aim. To study the prevalence of coronary atherosclerosis in patients referred to planned non-cardiac interventions of intermediate and high risk. Material and methods. This retrospective analysis included 397 medical histories of patients who underwent planned interventions on aorta, carotid arteries, and peripheral arteries, PA (341 men and 56 women; mean age 60,0±13,0 years). Carotid endarterectomy (CEA) was performed in 161 patients (40,6%); PA intervention in 160 (40,3%); and abdominal aortic reconstruction in 76 (19,1%). Comparisons were performed by coronary angiography (CAG) results and immediate intervention results. Results. According to the CAG data, coronary artery (CA) stenosis >70% was registered in 291 patients (73,3%). Significant CA stenosis was more common in patients referred to PA reconstruction, compared to patients referred to abdominal aortic reconstruction (p=0,005). However, three-vessel stenosis was observed in 11,9% and 22,4%, respectively (p for trend 0,003). The prevalence of left CA trunk stenosis and/or three-vessel stenosis was similar across all groups. Preventive myocardial revascularisation was performed significantly more often in patients referred to aortic intervention, compared to patients referred to CEA (p=0,005). Postintervention complications (predominantly local ones) were registered in 9,6% of the patients. Neurological complications were more common after CEA. Two CEA patients (1,3%) died of periprocedural myocardial infarction. Only one high-risk patient died (0,4%). No marked between-group difference in the risk of death was observed. Conclusion. In patients referred to non-cardiac interventions of intermediate and high risk, a hemodynamically significant stenosis of one main CA was registered in 30,5%, of two CA in 26,6%, and of three CA in 16,5%. A combination of left CA trunk stenosis and/or three-vessel stenosis was registered in 24,1%. Routine CAG provides an opportunity to select the patients with the high risk of cardiac complications during non-cardiac interventions, who might need preventive myocardial revascularisation.