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Noncardiac Surgery in Patients With Aortic Stenosis: A Contemporary Study on Outcomes in a Matched Sample From the Danish Health Care System

Author:
  • Charlotte Andersson
  • Mads Emil Jorgensen
  • Andreas Martinsson
  • Peter Waede Hansen
  • Gustav Smith
  • Per Foge Jensen
  • Gunnar H. Gislason
  • Lars Kober
  • Christian Torp-Pedersen
Publishing year: 2014
Language: English
Pages: 680-686
Publication/Series: Clinical Cardiology
Volume: 37
Issue: 11
Document type: Journal article
Publisher: Wiley-Blackwell

Abstract english

BackgroundPast research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30-day major adverse cardiovascular event (MACE) and all-cause mortality were investigated in a contemporary Danish cohort. HypothesisAS is not an independent risk factor for adverse outcomes in noncardiac surgery. MethodsAll patients with and without diagnosed AS who underwent noncardiac surgery in 2005 to 2011 were identified through nationwide administrative registers. AS patients (n=2823; mean age, 75.5years, 53% female) were matched with patients without AS (n=2823) on propensity score for AS and surgery type. ResultsIn elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death) occurred in 66/1772 (3.7%) of patients with AS and 52/1772 (2.9%) of controls (P=0.19), whereas mortality occurred in 67/1772 (3.8%) AS patients and 51/1772 (2.9%) controls (P=0.13). In emergency surgery, 163/1051 (15.5%) AS patients and 120/1051 (11.4%) controls had a MACE (P=0.006), whereas 225/1051 (21.4%) vs 179/1051 (17.0%) AS patients and controls died, respectively (P=0.01). Event rates were higher for those with symptoms (defined as use of nitrates, congestive heart failure, or use of loop diuretics), compared with those without symptoms (P<0.0001). ConclusionsAS is associated with high perioperative rates of MACE and mortality, but perhaps prognosis is, in practice, not much worse for patients with AS than for matched controls. Symptomatic patients and patients undergoing emergency surgery are at considerable risks of a MACE and mortality.

Keywords

  • Cardiac and Cardiovascular Systems

Other

Published
  • Hypertension and Cardiovascular Disease
  • ISSN: 1932-8737
E-mail: gustav.smith [at] med.lu.se

Associate professor

Cardiology

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D1232C

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Research project participant

Cardiovascular Epigenetics

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Research project participant

Heart Failure and Mechanical Support

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Project manager

Molecular Epidemiology and Cardiology

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