Catastrophic outcomes of noncardiac surgery soon after coronary stenting

Kałuża, Grzegorz L.; Joseph, Jane E.; Lee, Joseph R.; Raizner, Michael E; Raizner, Albert E.

doi:10.1016/s0735-1097(00)00521-0

Cited by 652 publications

(360 citation statements)

References 18 publications

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“…Prior coronary stenting is a well-established risk factor associated with major adverse cardiac events. 1,[16][17][18][19] More recently, however, Holcomb and colleagues demonstrated that the incremental risk of cardiac complications significantly decreases when surgery is performed more than 6 months following coronary stenting: the incremental risk of cardiac complications stabilizes at 1% beyond 6 months following coronary stenting. 20 Although NSQIP excludes those with prior percutaneous coronary intervention within 6 months of hepatectomy, we still found that those with history prior PCI (>6 months before the liver resection) had a cardiac complication rate of 6.4% as well as a three-fold increase risk of cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

Tran

Worhunsky

Spain

et al. 2016

HPB

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Section: Discussionmentioning

confidence: 99%

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

Tran

Worhunsky

Spain

et al. 2016

HPB

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“…Stents are expected to provide protection against postoperative AMI in noncardiac surgeries [14]; however, patients with AMI + a stent had a high risk of post-TKA AMI within 1 year of its placement. Previous studies to evaluate the risk of postoperative catastrophic events in the patients with a stent have reported variable recommendations about timing for surgery [10,19,24]. The high risk has been attributed to the discontinuation of antiplatelet drugs before the surgery [10,19,24].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies to evaluate the risk of postoperative catastrophic events in the patients with a stent have reported variable recommendations about timing for surgery [10,19,24]. The high risk has been attributed to the discontinuation of antiplatelet drugs before the surgery [10,19,24]. This high risk also suggests that the timing of the TKA for some patients with AMI + stent did not comply with the timing (after 6 months) recommended by ACC/AHA for patients after percutaneous coronary intervention.…”

Section: Discussionmentioning

confidence: 99%

Risk of Post-TKA Acute Myocardial Infarction in Patients With a History of Myocardial Infarction or Coronary Stent

Kumar

Tsai

Tan

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Acute myocardial infarction (AMI) is one of the most important perioperative complications of total knee arthroplasty (TKA). Although risk-stratification tools exist for the prediction of cardiac complications including AMI after noncardiac surgery, such stratification does not differentiate the patients with a coronary stent alone, AMI without a stent, or AMI with a stent. The risk of postoperative AMI in these patient groups may vary. Several studies have recommended suitable times for noncardiac surgery in patients with a coronary stent; however, they do not differentiate between the patients with AMI and no AMI. The suitable time of noncardiac surgery for patients with AMI and stent may vary from those with a stent alone. Moreover, a study to evaluate the risk of AMI within 1 year in an Asian population with a history of AMI or coronary stent who underwent TKA has not been reported. Questions/purposes (1) What are the risks of AMI within 1 year of TKA in patients who have had a stent alone, AMI without a stent, or AMI with a stent as compared with patients without an AMI/stent? (2) For patients with AMI/ stent placement, when can TKA be performed where the risk of subsequent AMI normalizes? (3) What comorbidities are associated with post-TKA AMI? (4) Is the risk of AMI within 1 year after surgery in patients undergoing TKA without a history of AMI/stent higher than that in patients with no surgery? Methods This study is a retrospective study of the medical claim records of 128,216 patients who underwent TKA between 1997 and 2010 in Taiwan. The records were retrieved from the research database of the Bureau of National Health Insurance in Taiwan, which maintains the records of 99.68% of the Taiwan population. The patients who had a history of AMI or coronary stent placement within the year before TKA were compared with the patients who had not experienced AMI or stent placement before TKA. The control subjects were matched according to sex, age, Charlson score, and year of surgery. There were 2413 patients in each group. The patients with a history of AMI or stent placement and the timing of TKA after coronary event were further stratified as with a coronary stent alone, AMI without a stent, and AMI with a Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Conclusions This study found the risk of post-TKA AMI remains high within 1 year in patients with a history of AMI/stent. It is recommended that an elective TKA should be performed at least 1 year after an episode of AMI or stent placement. Stents do not provide protection against post-TKA AMI within 6 months of the AMI and patients with AMI + stent have a higher risk of AMI than those with only AMI. Patients of AMI/stent on hemodialysis have a very high risk of post-TKA AMI. However, the risk of AM...

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“…61 Kaluza et al showed that non-cardiac surgery soon after BMS placement (often requiring aspirin withdrawal) was linked to a very high rate of adverse events. 62 A second report describes a patient who simultaneously received a BMS and a DES stent. 63 Twelve weeks later, the patient underwent knee surgery.…”

Section: Risk Of Coronary Events If Antiplatelet Medications Are Discmentioning

confidence: 99%

Brief review: Coronary drug-eluting stents and anesthesia

Dalal

Stanlies

Souza

et al. 2006

Can J Anesth/J Can Anesth

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Purpose: Anesthesiologists managing patients with drug-eluting stents (DES) face the challenge of balancing the risks of bleeding vs perioperative stent thrombosis (ST). This article reviews DES and the influence of antiplatelet medications related to their use. A perioperative management algorithm is suggested. Novel P2Y12 antagonists currently under investigation, including cangrelor and prasugrel are considered, as well as their potential role in modification of perioperative cardiovascular risks and management of patients with DES.Source: A PubMed search of the relevant literature over the period 1985-2005 was undertaken using the terms "drug-eluting stent", "coronary artery stent", "bare metal stent", "antiplatelet medication", "aspirin", "clopidogrel."Principal findings: Delayed re-endothelialization may render both sirolimus-eluting and paclitaxel-eluting stents susceptible to thrombosis for a longer duration than bare metal stents. Stent thrombosis may be associated with resistance to antiplatelet medication. In patients with a DES, a preoperative cardiology consultation is essential. Elective surgery should be postponed if the duration between DES placement and noncardiac surgery is less than six months. For semi-emergent procedures, both aspirin and clopidogrel should be continued during surgery unless clearly contraindicated by the nature of the surgery. If the risk of bleeding is high, then modification of antiplatelet medications should be considered on a case-by-case basis. Conclusion: A profound increase in the number of patients with DES requires anesthesiologists to be familiar with their associated antiplatelet medications, and strategies for risk modification of ST and possible hemorrhagic complications in the perioperative setting. Objectif

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Catastrophic outcomes of noncardiac surgery soon after coronary stenting

Abstract: Postponing elective noncardiac surgery for two to four weeks after coronary stenting should permit completion of the mandatory antiplatelet regimen, thereby reducing the risk of stent thrombosis and bleeding complications.

Cited by 652 publications

References 18 publications

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

The significance of underlying cardiac comorbidity on major adverse cardiac events after major liver resection

Risk of Post-TKA Acute Myocardial Infarction in Patients With a History of Myocardial Infarction or Coronary Stent

Brief review: Coronary drug-eluting stents and anesthesia

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