Clinical study
Aortic stenosis: an underestimated risk factor for perioperative complications in patients undergoing noncardiac surgery

https://doi.org/10.1016/j.amjmed.2003.07.012Get rights and content

Abstract

Purpose

To determine the incidence of perioperative events in patients with aortic stenosis undergoing noncardiac surgery.

Methods

We studied 108 patients with moderate (mean gradient, 25 to 49 mm Hg) or severe (mean gradient, ≥50 mm Hg) aortic stenosis and 216 controls who underwent noncardiac surgery between 1991 and 2000 at Erasmus Medical Center. Controls were selected based on calendar year and type of surgery. Details of clinical risk factors, type of surgery, and perioperative management were retrieved from medical records. The main outcome measure was the composite of perioperative mortality and nonfatal myocardial infarction.

Results

There was a significantly higher incidence of the composite endpoint in patients with aortic stenosis than in patients without aortic stenosis (14% [15/108] vs. 2% [4/216], P <0.001). This rate of perioperative complications was also substantially higher in patients with severe aortic stenosis compared with patients with moderate aortic stenosis (31% [5/16] vs. 11% [10/92], P = 0.04). After adjusting for cardiac risk factors, aortic stenosis remained a strong predictor of the composite endpoint (odds ratio = 5.2; 95% confidence interval: 1.6 to 17.0).

Conclusion

Aortic stenosis is a risk factor for perioperative mortality and nonfatal myocardial infarction, and the severity of aortic stenosis is highly predictive of these complications.

Section snippets

Study design

Between January 1991 and December 2000, a total of 123,802 consecutive patients over 18 years of age underwent noncardiac surgery at the Erasmus Medical Center, Rotterdam, The Netherlands. The hospital electronic database was reviewed for medical records of patients with a diagnosis of aortic stenosis who had undergone elective noncardiac surgery. One hundred and eight patients were identified as having moderate or severe aortic stenosis and as having undergone elective noncardiac surgery. From

Results

Patients with aortic stenosis were older, and had a higher prevalence of cardiac risk factors, including angina pectoris, myocardial infarction, heart failure, stroke, diabetes mellitus, renal failure, and hypertension, compared with patients without aortic stenosis (Table 1). More patients with aortic stenosis had a cardiac risk index of 1 or more compared with controls. Use of angiotensin-converting enzyme inhibitors, diuretics, and nitrates was also more common among patients with aortic

Discussion

Our results suggest that patients with aortic stenosis have a fivefold increased risk of perioperative mortality and nonfatal myocardial infarction, regardless of the presence of risk factors for coronary artery disease, such as angina, previous myocardial infarction, heart failure, renal dysfunction, and stroke. The severity of aortic stenosis was also highly predictive of perioperative adverse outcome.

These findings are in agreement with prior research and guidelines, based initially on the

References (15)

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