Cardiac Risk of Noncardiac Surgery after Percutaneous Coronary Intervention with Drug-eluting Stents

Jennifer A Rabbitts,David R Holmes,Michael J Brown,Gregory A Nuttall,Charanjit S Rihal,William C Oliver,Andrew C Hanson

doi:10.1097/aln.0b013e318186de1c

Abstract

The American College of Cardiology released a scientific advisory that included a recommendation to delay elective of noncardiac surgery (NCS) for 1 yr after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES). This single-center, retrospective study examined the risk for complications of NCS performed within 2 yr after DES placement and examined whether this risk changed based on the time between procedures. The primary endpoint was major adverse cardiac events (MACEs) during the hospitalization for NCS. Bleeding events were analyzed as a secondary endpoint. From April 22, 2003, to December 31, 2006, a total of 520 patients underwent NCS within 2 yr after PCI with a DES at Mayo Clinic. The majority, 84%, of the DES placed were Cypher stents. The frequency of MACE was not found to be significantly associated with the time between PCI and NCS (rate of MACEs 6.4, 5.7, 5.9, and 3.3% at 0-90, 91-180, 181-365, and 366-730 days after PCI with DES, respectively; P = 0.727 for comparison across groups). Characteristics found to be associated with MACEs in univariate analysis were advanced age (P = 0.031), emergent NCS (P = 0.006), shock at time of PCI (P = 0.035), previous history of myocardial infarction (P = 0.046), and continuation of a thienopyridine (ticlopidine or clopidogrel) into the preoperative period (P = 0.040). The rate of transfusion did not seem to be associated with antiplatelet therapy use. The risk of MACEs with NCS after DES placement was not significantly associated with time from stenting to surgery, but observed rates of MACEs were lowest after 1 yr.

Highlights

The American College of Cardiology released a scientific advisory that included a recommendation to delay elective of noncardiac surgery (NCS) for 1 yr after percutaneous coronary intervention (PCI) with a drug-eluting stent (DES)
The frequency of major adverse cardiac events (MACEs) was not found to be significantly associated with the time between PCI and NCS
We addressed whether an optimal delay after PCI with DES exists to minimize the perioperative risk of MACEs and bleeding events

Summary

Methods

This single-center, retrospective study examined the risk for complications of NCS performed within 2 yr after DES placement and examined whether this risk changed based on the time between procedures. After institutional review board approval, we identified 520 patients who underwent NCS after PCI with DES at Mayo Clinic, Rochester, Minnesota. Patient demographic data included risk factors for coronary artery disease, presenting condition at time of PCI (PCI performed on an elective basis or urgently for acute coronary syndrome, as well as pre-PCI cardiogenic shock), angiographic data (including number of stents placed, percent residual stenosis, postprocedural TIMI [Thrombolysis in Myocardial Infarction trial] flow, and successful PCI in all lesions stented), maintenance antiplatelet therapy (none, aspirin, ticlopidine or clopidogrel, or dual antiplatelet therapy), antiplatelet therapy before NCS (categorized as continued until Ͻ 7 days before NCS, discontinued 7–30 days before NCS, and not used during the month before NCS), type of NCS (categorized according to ACC–AHA classification),[15] urgency of NCS (nonemergent or emergent), and use of general anesthesia. All patients undergoing PCI at the Mayo Clinic have been prospectively followed up in a registry. Patients are prospectively contacted at 6 and 12 months and annually thereafter, and follow-up events are recorded

Results

Discussion

Conclusion