Abstract 13391: Characteristics of Patients Undergoing Diagnostic Cardiac Catheterization Before Noncardiac Surgery; The National Cardiovascular Data Registry (NCDR)

Abstract

Background: While cardiac catheterization and/or revascularization before noncardiac surgery is not routinely indicated, many patients undergo these procedures as part of a preoperative evaluation. The angiographic findings and treatment patterns of these patients are unknown. Methods: Using the NCDR CathPCI registry, we performed a descriptive analysis of 194,444 patients at 1,046 sites reporting both diagnostic catheterization and PCI data who had a coronary angiogram prior to site-reported noncardiac surgery between 2009-2014. Patients with ACS, cardiogenic shock, cardiac arrest, or emergency catheterization were excluded. Demographics, pre-procedure noninvasive testing, angiographic findings, and treatment recommendations were summarized. Results: Of the included patients, 58.2% were male, the median age was 65 (IQR 57-73), and 83.6% were white. Most were overweight or obese (78.6%) and 40.6% had diabetes. A minority had prior MI (17.7%), PCI (18.9%), or CABG (12.1%). Most patients were asymptomatic (60.6%), although 57.8% had been on anti-anginal medications within 2 weeks of the procedure. Prior stress testing was reported in 65.2% and was positive in 86.4% of these patients; stress MPI was most commonly used (85.9% of noninvasive tests). Obstructive CAD (≥50% LM; ≥70% other) was present in 48.1%. After diagnostic angiography, revascularization with PCI or CABG was recommended in 23.8% of the overall cohort, 23.1% of asymptomatic patients, and in 48.3% of patients with obstructive CAD. Treatment recommendations varied by findings (Table). Conclusions: In this large contemporary US registry, a majority (60%) of patients undergoing diagnostic catheterization prior to noncardiac surgery are asymptomatic. Obstructive CAD by angiography is common, and revascularization is recommended in ~50% of these patients. These data highlight the complexity in decision making regarding the role of angiography and revascularization in this setting.