The Incremental Risk of Noncardiac Surgery on Adverse Cardiac Events Following Coronary Stenting | Journal Scan

Study Questions:

What is the incremental risk of surgery on postoperative adverse cardiac events following coronary stent implantation?

Methods:

This was a matched retrospective cohort study of patients who had a coronary stent implanted between October 1999 and September 2009, at Veterans Affairs medical centers. The authors compared all patients with coronary stents undergoing noncardiac surgery in the 24 months following stent implantation to patients with coronary stents not undergoing subsequent surgery. Each patient undergoing surgery was matched to two patients who did not undergo surgery. The primary outcome was a composite endpoint of acute myocardial infarction and/or coronary revascularization within 30 days following surgery in the surgical cohort or the equivalent post-stent time period for the nonsurgical cohort.

Results:

A total of 20,590 surgical patients were matched to 41,180 nonsurgical patients. Compared to those who did not undergo surgery, those in the surgical population had higher rates of the primary outcome (3.1% vs. 1.9%, p < 0.001). Incremental risk of noncardiac surgery leveled off to 1% at 6 months, after which it remained stable through 24 months. The following factors were associated with a significant reduction in risk following surgery more than 6 months post-stent: elective inpatient procedure, high-risk surgery, and drug-eluting stent (DES).

Conclusions:

Risk for adverse cardiac events following noncardiac surgery in post-stent patients is highest in the 6 months following stenting, after which it stabilizes. Those undergoing high-risk inpatient surgery and with DES may stand to benefit most from delaying surgery to more than 6 months after stent placement.

Perspective:

This important study adds to our understanding of the risk of noncardiac surgery following coronary stent implantation. The rate of adverse cardiac events seems to level off after 6 months following a stent. The authors identified high-risk surgery and DES as two factors associated with a significant reduction in risk following surgery more than 6 months after stent placement; accordingly, these groups may stand to benefit especially if noncardiac surgery can be delayed. It should be noted that the authors were unable to measure the effects of antiplatelet therapies.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention

Keywords: Cardiovascular Diseases, Drug-Eluting Stents, Stents, Myocardial Revascularization, Risk, Inpatients, Prospective Studies, Cohort Studies


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