Primary Reasons for MACE Following Noncardiac Surgery in Patients With Stents

"The biggest predictors of major adverse cardiac events (MACE) were recent MI within 6 months, an overall cardiac risk index as a standard, and then also non-elective surgery, so some of the more basic things, but stent type was not a factor," said Christopher Cannon, MD, FACC.

Among patients undergoing noncardiac surgical procedures within two years of stent implantation, major adverse cardiac events (MACE) are more likely associated with emergency surgical indications than with stent type or timing of surgery beyond six months after intervention.

The retrospective analysis, published online in the Journal of the American Medical Association, included 28,029 patients who underwent noncardiac surgery within 24 months of stent implantation. MACE occurred in 4.7 percent of these patients. In multivariate analysis, factors significantly associated with MACE were nonelective surgical admission (adjusted odds ratio [AOR] 4.77; 95 percent CI, 4.07-5.59), history of MI in the six months prior to surgery, (AOR 2.63; 95 percent CI, 2.32-2.98) and a revised cardiac index >2 (AOR, 2.13; 95 percent CI, 1.85-2.44). Surgery within six months of stenting, but not beyond, was also significantly associated with MACE (p<0.0001). Stent type (drug-eluting versus bare-metal) was not associated with MACE after six months.

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"Predominant risk factors for MACE after noncardiac surgery in patients with recent coronary stent implantation included nonelective surgical presentation and conditions associated with advanced ischemic cardiac disease," wrote the investigators. The time between stent placement and surgery was a less important predictor of MACE, and stabilized at six months following stent placement. MACE risk according to stent type also stabilized at six months. "Guideline emphasis on stent type and timing for both DES and BMS should be re-evaluated," they concluded.

In an accompanying editorial, Emmanouil S. Brilakis, MD, and Subhash Banerjee, MD, both of University of Southwestern Texas Medical Center, Dallas, write that the study "provides good scientific evidence to a field and a common clinical question that have been, and continue to be, dominated by expert opinion." However, they note that current approaches to recently stented patients requiring surgery should not change based on the study's findings.

Keywords: Heart Diseases, Odds Ratio, Expert Testimony, Multivariate Analysis, Risk Factors, United States, Stents

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