Coronary stent implantation and adverse cardiac events after surgery

Abstract

Background In the risk assessment of patients considered for non‐cardiac surgery and with recent coronary stent implantation, coronary drug‐eluting stent implantation procedure characteristics may be taken into account. We aimed to evaluate associations between coronary drug‐eluting stent implantation procedure characteristics and the risk of myocardial infarction and all‐cause death within 30 days after non‐cardiac surgery. Design Patients with coronary drug‐eluting stents were identified using the Western Denmark Heart Registry. Surgical procedures performed after stent implantation were detected using the Danish National Patient Registry. We used registry‐based detection of myocardial infarction and all‐cause death. Results Of 22 590 patients treated with drug‐eluting stents between 2005 and 2012, 4046 underwent non‐cardiac surgery within 1 and 12 months after stent implantation. We found no significant association between the risk of myocardial infarction or all‐cause death within 30 days after surgery and number of arteries treated (1 [reference] vs more), number of lesions treated (1 [reference] vs more), segments treated (left main and proximal left anterior descending artery vs other [reference]), total stent length (<20 mm [reference] vs ≥20 mm), number of stents (1 [reference] vs >1) and largest balloon diameter (≥3 mm [reference] vs <3 mm). All‐cause death, but not myocardial infarction, risk was lower among patients treated with first‐generation vs second‐generation stents (odds ratio 0.58). Conclusions We identified no significant associations between stent implantation procedure characteristics and risk of myocardial infarction or all‐cause death among patients undergoing non‐cardiac surgery. All‐cause death was lower with first‐ vs second‐generation drug‐eluting stents.

Risk of Myocardial Infarction and Death After Noncardiac Surgery Performed Within the First Year After Coronary Drug-Eluting Stent Implantation for Acute Coronary Syndrome or Stable Angina Pectoris

“…In the overall cohort, we previously found no association between the number of implanted stents and the risk of MI or all-cause death within 30 days after surgery. 17 The Danish registries used in this study include large cohorts across all social classes and both genders and provide validated outcome measures with very limited loss to follow-up. [8][9][10][11][12]18 However, being a database study it lacks clinical detail, and we have no information on peri-operative management of DAPT, which may impact the outcomes assessed in this study.…”

The timing of surgical interventions following the implantation of coronary drug-eluting stents in patients undergoing gastrointestinal cancer surgery: A multicenter retrospective cohort study

“…Barash et al indicated that early NCS within 3 months of DES implantation may be associated with adverse clinical outcomes[34]. Delaying elective NCS by at least 3 months after DES implantation seems safe and feasible with no significant postoperative adverse cardiac events[35]. By establishing a logistic regression formula linking the variable "Time of surgery" to MACEs, based on the Youden index, the study calculates the time point corresponding to the threshold probability as the 87th day.…”

Perioperative implications of newer generation drug-eluting coronary stents: A narrative review

“…Six studies analysed the incidence of MACEs in relation to the time from PCI to NCS, and compared first and newer generation DESs (Table 1). 9,[22][23][24][25][26] Only one study included patients with third and fourth generation DESs. 22 No study demonstrated a significantly increased risk of MACEs once three months had elapsed between stent implantation and NCS.…”

“…24 Thim and colleagues subsequently performed another retrospective analysis on data from the Danish National Patient Registry and reported that first generation DESs were associated with a statistically significant reduction (adjusted OR 0.66) in all-cause death (but not MI) compared with second generation DESs. 26 The final relevant study was a retrospective cohort by Lo et al, in which 81.4% of patients had second generation DESs. 23 The incidence of MACEs was highest (9.1%) when surgery was performed within 45 days of stent implantation but this did not reach statistical significance.…”

“…17 The recommended minimum time for performing elective NCS following second generation DES placement was reduced from one year to six months, and NCS could be considered after three months if the risk of delaying surgery was considered to be greater than the risk of stent thrombosis. 18,19 This recommendation was based on multiple non-inferiority studies, [20][21][22][23][24][25][26] which demonstrated that six months of DAPT following second generation DES placement was not associated with a higher risk of ischaemic events compared to 12-24 months of DAPT, with a lower risk of major bleeding. If the DES had been placed for the treatment of an acute coronary syndrome (ACS), the guideline suggested delaying elective surgery for at least 12 months.…”