Abstract 13946: Subclinical Atherosclerosis and Peri-Operative Cardiac Events in Patients Undergoing Peripheral Bypass Surgery

Abstract

Introduction: Coronary artery disease (CAD) is associated with a higher risk of peri-operative adverse events after vascular surgery. Subclinical CAD, defined as presence of coronary calcium, has not been established as a risk factor for adverse events after vascular surgery. Hypothesis: We sought to describe the epidemiology and peri-operative outcomes in patients with subclinical coronary atherosclerosis (SCA) undergoing supra- and infra-inguinal peripheral bypass. Methods: Using the Vascular Quality Initiative, we identified patients at a single institution undergoing supra- and infra-inguinal peripheral bypass surgery (2009-2020). Retrospective chart review was performed to identify chest computed tomography (CT) within one year prior to revascularization; imaging was reviewed for presence of coronary calcifications, a marker of SCA. Individuals were stratified by: no atherosclerosis, SCA, and CAD. Comorbidities and peri-operative outcomes were compared among groups with the chi-square or ANOVA, as appropriate. Results: Of 1018 patients undergoing peripheral bypass surgery, 199 (20%) had a CT available. SCA was noted in 96 patients (48%) while 72 (36%) had known CAD. Patients with SCA had similar comorbidities to patients with CAD (Table) but were less likely to be on a pre-operative beta-blocker or P2Y12 inhibitor. The incidence of postoperative myocardial infarction and congestive heart failure was similar in patients with SCA (13% and 9%, respectively) as those with CAD (10%, 6% respectively), compared to those without atherosclerosis (3% and 0, respectively). Conclusions: SCA is common in patients undergoing peripheral bypass surgery and is associated with a risk of peri-operative myocardial infarction or congestive heart failure similar to occult CAD. Aggressive secondary prevention measures should be considered in patients with polyvascular disease, including subclinical CAD.