Surgery Within 12 Months After DES Implantation

Study Questions:

What is the surgical risk associated with drug-eluting stent by percutaneous coronary intervention (DES-PCI) compared with that in nonstented patients without ischemic heart disease (IHD)?

Methods:

Between 2005 and 2012, a total of 22,590 patients underwent DES-PCI in western Denmark. By record-linking the Western Denmark Heart Registry and the Danish National Patient Register, the investigators evaluated 4,303 DES-PCI–treated patients with a surgical procedure and compared them with a control group of patients without previous IHD undergoing similar surgical procedures (n = 20,232). Events of interest were myocardial infarction (MI), cardiac death, and all-cause mortality within 30 days after surgery.

Results:

Surgery in DES-PCI–treated patients was associated with an increased risk of MI (1.6% vs. 0.2%; odds ratio [OR], 4.82; 95% confidence interval [CI], 3.25-7.16) and cardiac death (1.0% vs. 0.2%; OR, 5.87; 95% CI, 3.60-9.58), but not all-cause mortality (3.1% vs. 2.7%; OR, 1.12; 95% CI, 0.91-1.38). When stratified for time from PCI to surgery, only surgery within the first month was associated with a significant increased risk of events.

Conclusions:

The authors concluded that patients requiring surgery within 12 months after DES-PCI had an increased risk of MI and cardiac death compared with patients without IHD.

Perspective:

This retrospective study reports that surgery in patients treated with DES-PCI was associated with an increased 30-day risk of MI, but did not increase 30-day all-cause mortality, and beyond the first month after stent implantation, DES-PCI–treated patients had the same perioperative risk as surgery in patients without IHD. The increased risk was only present within the first month after DES-PCI, suggesting that surgery might be undertaken earlier than currently recommended. Given several limitations of this analysis including lack of data on delay or even cancellation of some major surgical procedures and the antithrombotic therapy management during the surgery, additional studies are needed to define the optimal approach to antithrombotic therapy in patients undergoing noncardiac surgery in the 12 months after DES implantation.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Prevention, Interventions and Coronary Artery Disease

Keywords: Coronary Artery Disease, Drug-Eluting Stents, Fibrinolytic Agents, Myocardial Infarction, Myocardial Ischemia, Percutaneous Coronary Intervention, Risk Assessment, Secondary Prevention, Stents, Surgical Procedures, Operative


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