Perioperative CV Risk of Prior Stents and Noncardiac Surgery

Study Questions:

What is the association between prior coronary stent implantation and occurrence of cardiovascular events in patients undergoing noncardiac surgery?

Methods:

The investigators assessed the outcome of 24,313 noncardiac surgery patients, of whom 1,120 (4.6%) had history of prior coronary stents. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of death, myocardial infarction, stroke, or cardiac arrest. Propensity matching was used to adjust for revised cardiac risk index and other comorbidities.

Results:

The 30-day MACCE rate was higher in patients with prior coronary stents (3.7% vs. 1.5%, p < 0.001). The risk of MACCE was increased in the first year after stenting (adjusted odds ratio [OR], 2.59; 95% confidence interval [CI], 1.36-4.94), but there was no excessive risk after the first year (adjusted OR, 0.89; 95% CI, 0.59-1.36). Bleeding was similarly increased in the first year (adjusted OR, 2.23), but not subsequently. The excess risk of MACCE in 6-12 months after stent implantation was elevated in those treated with bare-metal stents (BMS; adjusted OR, 4.21) as well as in those with drug-eluting stents (DES; adjusted OR, 1.03).

Conclusions:

Prior coronary stent implantation is associated with increased risk of MACCE in those undergoing noncardiac surgery within 1 year of stent implantation.

Perspective:

The optimal timing of noncardiac surgery in patients with prior coronary stents remains a common clinical dilemma. The results of this study suggest that the increased risk of MACCE in these patients persists up to 1 year and was seen with both DES and BMS. Furthermore, the increased risk of MACCE was driven by both stent-related and non–stent-related events. Further research is needed to define the best approach for management of patients with prior stents who need noncardiac surgery.

Clinical Topics: Arrhythmias and Clinical EP, Invasive Cardiovascular Angiography and Intervention, Implantable Devices, SCD/Ventricular Arrhythmias

Keywords: Comorbidity, Drug-Eluting Stents, Heart Arrest, Hemorrhage, Myocardial Infarction, Risk Factors, Stents, Stroke, Surgical Procedures, Operative


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