Perioperative CV Risk of Prior Stents and Noncardiac Surgery
What is the association between prior coronary stent implantation and occurrence of cardiovascular events in patients undergoing noncardiac surgery?
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.
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).
Prior coronary stent implantation is associated with increased risk of MACCE in those undergoing noncardiac surgery within 1 year of stent implantation.
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.
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