Abstract
This study aimed to examine the 30-day risk of myocardial infarction (MI) and death in patients who underwent noncardiac surgery within 1year after coronary drug-eluting stent implantation for acute coronary syndrome (ACS) or stable angina pectoris (SAP) and to compare it with the risk in surgical patients without known coronary artery disease. Patients with drug-eluting stent implantation for ACS (n=2,291) or SAP (n=1,804) who underwent noncardiac surgery were compared with a cohort from the general population without known coronary artery disease matched on the surgical procedure, hospital contact type, gender, and age. In patients with ACS, the 30-day MI risk was markedly increased when surgery was performed within 1month after stenting (10% vs 0.8%; adjusted odds ratio [ORadj] 20.1, 95% confidence interval [CI] 8.85 to 45.6), whereas mortality was comparable (10% vs 8%, ORadj 1.17, 95% CI 0.76 to 1.79). When surgery was performed between 1 and 12months after stenting, the 30-day absolute risk for MI was low but higher than in the comparison cohort (0.6% vs 0.2%, ORadj 2.18, 95% CI 0.89 to 5.38), whereas the mortality risks were similar (2.0% vs 1.8%, ORadj 1.03, 95% CI 0.69 to 1.55). In patients with SAP, the 30-day MI risk was low but higher than in the comparison cohort (0.4% vs 0.2%, ORadj 1.90, 95% CI 0.70 to 5.14), whereas the mortality risks were similar (2.2% vs 2.1%, ORadj 0.91, 95% CI 0.61 to 1.37). In conclusion, patients with ACS and SAP who underwent surgery between 1 and 12months after stent implantation had a risk for MI and death that was similar to the risk observed in surgical patients without coronary artery disease.
Highlights
Geons, evaluates the indication for and timing of the surgery and the consequences of interrupting dual antiplatelet therapy (DAPT)
The main findings of our study are as follows: (1) Noncardiac surgery within the first month after DES implantation in patients with acute coronary syndrome (ACS) was associated with a 30-day risk for both myocardial infarction (MI) and death that approximated 10%
(2) Noncardiac surgery performed later than 1 month after DES implantation for ACS was associated with a
Summary
Geons, evaluates the indication for and timing of the surgery and the consequences of interrupting dual antiplatelet therapy (DAPT) Such consequences include an increased risk of thrombotic events such as stent thrombosis and risk of bleeding associated with surgery.[4,5] Based on 2 recent cohort studies,[3,6] the 2018 European Society of Cardiology DAPT consensus document suggested that when surgical delay is undesired, elective surgery may be considered 1 month after DES implantation for stable angina pectoris (SAP) and 6 months after DES implantation for acute coronary syndrome (ACS).[5] the evidence for this recommendation is limited. The risk in patients treated for ACS or SAP was compared separately with the risk in a comparison cohort of patients from the general population without coronary artery disease who underwent similar surgical procedures
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