Previous Coronary Stent Implantation and Cardiac Events in Patients Undergoing Noncardiac Surgery

Authors:
  • SHScott A. Harding
    Scott A. Harding
  • AFAndrew D. Flapan
    Andrew D. Flapan
  • CGCat Graham
    Cat Graham
  • SWSarah H. Wild
    Sarah H. Wild
  • RSRachel Slack
    Rachel Slack
  • DNDavid E. Newby
    David E. Newby
  • OCon behalf of the Scottish Coronary Revascularisation Register Steering Committee
    on behalf of the Scottish Coronary Revascularisation Register Steering Committee
Open Access
Publisher website
Google Scholar
Abstract
Background—: Noncardiac surgery performed after coronary stent implantation is associated with an increased risk of stent thrombosis, myocardial infarction, and death. The influence of stent type and period of risk still have to be defined. Methods and Results—: We linked the Scottish Coronary Revascularisation Register with hospital admission data to undertake a Scotland-wide retrospective cohort study examining cardiac outcomes in all patients who received drug-eluting or bare-metal stents between April 2003 and March 2007 and subsequently underwent noncardiac surgery. Of 1953 patients, 570 (29%) were treated with at least 1 drug-eluting stent and 1383 (71%) with bare-metal stents only. There were no differences between drug-eluting and bare-metal stents in the primary end point of in-hospital mortality or ischemic cardiac events (14.6% versus 13.3%; P =0.3) or the secondary end points of in-hospital mortality (0.7% versus 0.6%; P =0.8) and acute myocardial infarction (1.2% versus 0.7%; P =0.3). Perioperative death and ischemic cardiac events occurred more frequently when surgery was performed within 42 days of stent implantation (42.4% versus 12.8% beyond 42 days; P P =0.037). There were no temporal differences in outcomes between the drug-eluting and bare-metal stent groups. Conclusions—: Patients undergoing noncardiac surgery after recent coronary stent implantation are at increased risk of perioperative myocardial ischemia, myocardial infarction, and death, particularly after an acute coronary syndrome. For at least 2 years after percutaneous coronary intervention, cardiac outcomes after noncardiac surgery are similar for both drug-eluting and bare-metal stents.

This publication has 33 references indexed in Scilit: