Outcomes of noncardiac surgery after coronary bypass surgery or coronary angioplasty in the Bypass Angioplasty Revascularization Investigation (BARI)

Hassan, Sohail; Hlatky, Mark A.; Boothroyd, Derek B.; Winston, Carla A.; Mark, Daniel B.; Brooks, Maria M.; Eagle, Kim A.

doi:10.1016/s0002-9343(00)00717-8

Cited by 108 publications

(29 citation statements)

References 31 publications

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“…196,197 To date, this study remains the largest and most comprehensive economic evaluation of alternative revascularisation strategies for patients with multiple-vessel coronary disease. Among 934 patients randomised to PTCA or bypass surgery, initial cost of care was 35% lower with PTCA [$21,113 (£13,124) versus $32,347 (£20,107)].…”

Section: Percutaneous Versus Surgical Revascularisation For Multivessmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NHS R&D HTA ProgrammeT he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly influence key decision-making bodies such as the National Institute for Clinical Excellence (NICE) and the National Screening Committee (NSC) who rely on HTA outputs to help raise standards of care. HTA findings also help to improve the quality of the service in the NHS indirectly in that they form a key component of the 'National Knowledge Service' that is being developed to improve the evidence of clinical practice throughout the NHS.The HTA Programme was set up in 1993. Its role is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care.The HTA programme commissions research only on topics where it has identified key gaps in the evidence needed by the NHS. Suggestions for topics are actively sought from people working in the NHS, the public...

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Section: Percutaneous Versus Surgical Revascularisation For Multivessmentioning

confidence: 99%

Coronary artery stents: a rapid systematic review and economic evaluation

Hill¹,

Bagust²,

Bakhai³

et al. 2004

Health Technol Assess

144

View full text Add to dashboard Cite

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“…After full article readings, seven manuscripts comprising 3,949 patients were included. 22,[27][28][29][30][31][32] Ten articles were rejected due to various reasons: lack of comparison with medical management, 33,34 lack of subsequent noncardiac surgery, [35][36][37][38][39][40][41] and outcome report inconsistent with our review criteria 42,43 ( Figure 1). Data were extracted from these seven trials published between 1997 and 2005, one randomized controlled trial, 22 and six retrospective studies.…”

Section: Resultsmentioning

confidence: 99%

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

Wong

Lawrence

Wong

2007

Can J Anesth/J Can Anesth

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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. 0,85 (0,48-1,50) et de 0,95 (0,44-2,08)

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“…The benefit of PCI, in the short term, is that the risk of stroke is decreased sixfold in PCI patients compared to CABG. 17 Landesberg et al, in an observational propensity matched study, A have shown that CABG is superior to PCI for long-term outcomes. 18 The benefit was not apparent until three to four years after surgery.…”

Section: Is the Preoperative Assessment Accurate?mentioning

confidence: 99%

“…The early results from BARI show diabetics have a much higher mortality after PCI. 17 The newer PCI and stent technology requires prolonged use of anticoagulant and antiplatelet therapy, which will increase the interval between diagnosis and surgery. Coronary artery surgery also continues to improve.…”

Section: Is the Preoperative Assessment Accurate?mentioning

confidence: 99%

Evidence-based perioperative risk reduction

Beattie

2005

Can J Anesth/J Can Anesth

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HE purpose of this article is to examine the perioperative cardiac risk evidence and comment on the recommendations stemming from the evidence. We will assess the effect the evidence and the recommendations have had on practice.T Th he e d di il le em ma a Have the changes made to perioperative practice modified outcomes?Death is four times more common on the first day after surgery than the death rate in an age and risk adjusted population not having surgery.1 More than 50% of these deaths are a direct result of cardiovascular insult. The hospital costs for a postoperative cardiac related death double.2 The costs of a postoperative myocardial infarction (MI) are 50% higher than uncomplicated surgery. Furthermore, patients who survive a postoperative MI, are twice as likely to die in the next two years as patients having uncomplicated surgery. 3 The last decade has seen the introduction of preoperative assessment strategies, the America College of Cardiology and the American Heart Association (ACC/AHA) guidelines, new drugs, and minimally invasive surgical techniques. With these "improvements" there is no evidence that we have been able to alter postoperative mortality rates.Are we doing something wrong?T Th he e p pe er ri io op pe er ra at ti iv ve e a as ss se es ss sm me en nt t We undertake risk stratification in the hope that by doing so we can institute therapy that will favourably alter outcome. This implies that the strategies are accurate, and once identifying a high-risk patient, that there are effective modes to reduce risk. Is the preoperative assessment accurate?The delineation of risk begins with a good history and physical examination. There are several preoperative assessment strategies published. These strategies are not widely employed in clinical practice, most being too cumbersome or hard to remember. Table I compares three of the available risk indices. The revised cardiac risk index (RCRI) 4 is the most accurate and the easiest to remember. The RCRI has now been employed in several clinical trails to stratify for risk. We need to adopt the RCRI more widely.The risk indices perform best when coupled with the results of preoperative cardiac testing. The easiest test is a routine electrocardiogram (EKG). The finding of any abnormality in high-risk patients triples the perioperative risk. A normal EKG in a low risk patient has little discrimination. A 2D echocardiograph can be used in many ways to discriminate risk. The full potential of resting 2D echocardiogram has not been exploited at present. There is good evidence that estimation of ventricular function delineates risk.5-7 The finding of mitral regurgitation has also been linked to poor cardiac outcomes.6 Finally, the demonstration of aortic stenosis has been shown to increase perioperative cardiac risk. 8The ACC/AHA guidelines suggest that the best test, for preoperative cardiac risk stratification, is an exercise EKG. However, the demonstration of ST depression in women is not as sensitive or specific as it is in men, 30% of patients h...

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Outcomes of noncardiac surgery after coronary bypass surgery or coronary angioplasty in the Bypass Angioplasty Revascularization Investigation (BARI)

Cited by 108 publications

References 31 publications

Coronary artery stents: a rapid systematic review and economic evaluation

Coronary artery stents: a rapid systematic review and economic evaluation

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

Evidence-based perioperative risk reduction

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