Risk of Elective Major Noncardiac Surgery After Coronary Stent Insertion

Wijeysundera, Duminda N.; Wijeysundera, Harindra C.; Yun, Lingsong; Wąsowicz, Marcin; Beattie, W. Scott; Velianou, James L.; Ko, Dennis T.

doi:10.1161/circulationaha.112.102715

Cited by 149 publications

(94 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…149 However, recent data have suggested that, beyond six months following newer-generation DES implantation-and, for some specific DES devices, beyond three months of DES implantation-the perioperative cardiac event rates may be acceptable. 126,132,150 Independently of the interval between DES implantation and surgery, aspirin should be continued and, in cardiac-stable/asymptomatic patients with recent myocardial infarction treated with stenting, the timing of non-cardiac, non-urgent surgery will in part be dictated by the type of stent implanted.…”

Section: Revascularizationmentioning

confidence: 99%

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Kristensen¹,

Knuuti²,

Saraste³

et al. 2014

Revista Española de Cardiología (English Edition)

View full text Add to dashboard Cite

“…Our group has used these data extensively to perform evaluative analyses. [12][13][14][15] We used the Ontario Health Insurance Plan claims database, which captures information on services provided by practising physicians, to identify physician visits and stress testing. We used the Canadian Institute for Health Information Discharge Abstract Database, which includes information about hospital admissions, to identify inhospital stress testing and additional comorbidities.…”

mentioning

confidence: 99%

Stress testing after percutaneous coronary interventions: a population-based study

et al. 2017

Self Cite

View full text Add to dashboard Cite

Background: Routine stress testing is commonly used after percutaneous coronary intervention (PCI) to detect in-stent restenosis or suboptimal procedure results; however, recent studies suggest that such testing is rarely indicated. Our main objectives were to assess temporal trends in utilization of stress testing and to determine factors associated with its use. Methods:We conducted an observational study involving all patients who had undergone PCI in Ontario, Canada, from Apr. 1, 2004, to Mar. 31, 2012. The main outcome was stress testing within 2 years after PCI. We constructed multivariable logistic regression models to determine factors associated with the use of stress tests. Results:Our cohort consisted of 128 380 patients who underwent PCI procedures. The 2-year rate of stress testing declined significantly, from 68.1% among patients who underwent PCI in 2004 to 60.4% in 2012 (p < 0.001). Similar reductions were observed regardless of patients' risk of restenosis and type of stent received. Patients who were older or had diabetes mellitus, prior myocardial infarction, heart failure or other comorbidities were significantly less likely to undergo stress testing. In contrast, patients with higher income and those whose PCI was performed in a nonteaching hospital were significantly more likely to undergo stress testing. Interpretation:We observed a decrease in the use of stress testing after PCI procedures over time. However, stress tests were not performed in accordance with patients' higher baseline risk of adverse outcomes or risk of restenosis. Instead, many nonclinical factors, such as patients' socioeconomic status and hospitals' teaching status, were associated with higher use of stress tests. AbstractResearch Research CMAJ OPEN E418CMAJ OPEN, 5(2)testing after PCI and to determine factors associated with its use. Methods Data sourcesPCI data were obtained from the Cardiac Registry of the Cardiac Care Network of Ontario, which collects information about all patients undergoing cardiac catheterization, PCI, cardiac surgery and electrophysiology procedures in Ontario. Nurse coordinators at each cardiac invasive care centre gather data on demographic and clinical characteristics, procedure characteristics (including stent type) and relevant comorbid conditions. Our group has used these data extensively to perform evaluative analyses. [12][13][14][15] We used the Ontario Health Insurance Plan claims database, which captures information on services provided by practising physicians, to identify physician visits and stress testing. We used the Canadian Institute for Health Information Discharge Abstract Database, which includes information about hospital admissions, to identify inhospital stress testing and additional comorbidities. We used the Ontario Registered Persons Database, which contains vital statistics for all Ontarians, to determine rural residence and death after the index event. Finally, we used Statistics Canada census data to determine the socioeconomic status of each patient. We link...

show abstract

Risk of Elective Major Noncardiac Surgery After Coronary Stent Insertion

Cited by 149 publications

References 34 publications

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

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

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

Stress testing after percutaneous coronary interventions: a population-based study

Contact Info

Product

Resources

About