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Canadian Journal of Anesthesia 54:705-717 (2007)
© Canadian Anesthesiologists' Society, 2007
Reports of Original Investigations

The effects of prophylactic coronary revascularization or medical management on patient outcomes after noncardiac surgery - a meta-analysis

[Les effets de la revascularisation coronarienne prophylactique ou de la prise en charge médicale sur le devenir des patients après une chirurgie non-cardiaque : une méta-analyse]

Elise Y.W. Wong, DDS*, Herenia P. Lawrence, PhD{dagger} and David T. Wong, MD*,{ddagger}

* From the Departments of Dental Anesthesia,
{dagger} Biological and Diagnostic Sciences, Faculty of Dentistry; and the
{ddagger} Department of Anesthesia, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. David T. Wong, Department of Anesthesiology, MC 2-405, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Phone: 416-603-5118; Fax: 416-603-6494; E-mail: david.wong{at}uhn.on.ca

Purpose: The benefits of prophylactic coronary revascularization for patients undergoing noncardiac surgery are uncertain. The purpose of this study was to systematically evaluate the effect of coronary revascularization and medical management on short- and long-term outcomes after noncardiac surgery.

Method: Ten electronic databases including MEDLINE and EMBASE (1980 to February 2006), and bibliographies of included articles were searched without language restrictions. Studies comparing effects of coronary revascularization and medical management before noncardiac surgery were included. Patient outcome data including perioperative mortality, myocardial infarction, long-term mortality, or late adverse cardiac events were extracted and entered into a meta-analysis.

Results: The quality of published evidence was modest, comprising one randomized controlled trial and six retrospective studies. A total of 3,949 patients undergoing high-risk noncardiac surgery were included in the quantitative analysis. There was no significant difference between coronary revascularization and medical management groups with regards to postoperative mortality and myocardial infarction; the odds ratios (95% confidence intervals) were 0.85 (0.48–1.50) and 0.95 (0.44–2.08), respectively. There were no long-term outcome benefits associated with prophylactic coronary revascularization; the odds ratios (95% confidence intervals) were 0.81 (0.40–1.63) and 1.65 (0.70–3.86) for long-term mortality and late adverse cardiac events, respectively.

Conclusion: In patients with stable coronary artery disease, prophylactic coronary revascularization before high-risk noncardiac surgery does not confer any beneficial effects, when compared with optimized medical management, in terms of perioperative mortality, myocardial infarction, long-term mortality, or adverse cardiac events.






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