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