Previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery.
نویسندگان
چکیده
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<0.001), especially in patients revascularized after an acute coronary syndrome (65% versus 32%; 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.
منابع مشابه
Letter by Lozano et al regarding article "previous coronary stent implantation and cardiac events in patients undergoing noncardiac surgery".
متن کامل
Noncardiac surgery in patients with coronary artery stents.
T HE MANAGEMENT OF PATIENTS WHO UNdergo coronary artery stent implantation and subsequently require noncardiac surgery is a real and challenging clinical problem. In 2008, more than 800 000 percutaneous coronary procedures were performed in the United States, with coronary stents implanted in over 96% of cases. Approximately 5% of patients undergo noncardiac surgery in the 12 months following c...
متن کاملRisk of major adverse cardiac events following noncardiac surgery in patients with coronary stents.
IMPORTANCE Guidelines recommend delaying noncardiac surgery in patients after coronary stent procedures for 1 year after drug-eluting stents (DES) and for 6 weeks after bare metal stents (BMS). The evidence underlying these recommendations is limited and conflicting. OBJECTIVE To determine risk factors for adverse cardiac events in patients undergoing noncardiac surgery following coronary ste...
متن کاملInterventional Cardiology Risk of Elective Major Noncardiac Surgery After Coronary Stent Insertion A Population-Based Study
Background—Guidelines recommend that noncardiac surgery be delayed until 30 to 45 days after bare-metal stent implantation and 1 year after drug-eluting stent implantation. Methods and Results—We used linked registry data and population-based administrative health care databases to conduct a cohort study of 8116 patients (Ն40 years of age) who underwent major elective noncardiac surgery in Onta...
متن کاملRisk of elective major noncardiac surgery after coronary stent insertion: a population-based study.
BACKGROUND Guidelines recommend that noncardiac surgery be delayed until 30 to 45 days after bare-metal stent implantation and 1 year after drug-eluting stent implantation. METHODS AND RESULTS We used linked registry data and population-based administrative health care databases to conduct a cohort study of 8116 patients (≥40 years of age) who underwent major elective noncardiac surgery in On...
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ورودعنوان ژورنال:
- Circulation. Cardiovascular interventions
دوره 3 3 شماره
صفحات -
تاریخ انتشار 2010