Document Detail

Characterization of post-operative risk associated with prior drug-eluting stent use.
MedLine Citation:
PMID:  19539259     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to assess risk of inpatient surgery at any time after percutaneous coronary intervention (PCI) with drug-eluting stents (DES).
BACKGROUND: Risk of adverse events, including stent thrombosis (ST), in patients undergoing surgical procedures with prior DES remains poorly defined.
METHODS: Outcomes of consecutive patients having inpatient surgical procedures after PCI with DES, placed from April 28, 2003 until December 31, 2006 at a tertiary-care medical center, were studied. Primary and secondary end points were 30-day post-operative risk of the Academic Research Consortium (ARC) definite and modified probable definitions of ST and combined 30-day post-operative risk of death, nonfatal myocardial infarction (MI), or ST, respectively. Multivariable logistic regression analyses were used to determine independent risk factors.
RESULTS: Six hundred six inpatient surgeries on 481 patients with a mean time from PCI to surgery of 1.07 +/- 0.89 years were evaluated. The primary and secondary end points occurred after 11 (2.0%) and 56 (9%) surgeries, respectively. Risk of the combined end point and ST decreased significantly in the first 1 to 6 months after PCI (p < 0.0001 and p < 0.014, respectively); however, risk persisted when time between PCI and surgery was >12 months. Independent correlates of the combined end point include emergency surgery, antecedent MI, the pre-operative use of intravenous heparin, and atherosclerotic lesion length treated with DES. Oral antiplatelet status at time of surgery was not a correlate of events.
CONCLUSIONS: Risk of 30-day post-operative adverse events, including ST, remains significantly higher when surgery is performed soon after PCI, while intermediate-term risk extending at least 2 to 3 years remains important.
Saif Anwaruddin; Arman T Askari; Hammad Saudye; Lilian Batizy; Penny L Houghtaling; Mohammad Alamoudi; Michael Militello; Kamran Muhammad; Samir Kapadia; Stephen G Ellis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular interventions     Volume:  2     ISSN:  1876-7605     ISO Abbreviation:  JACC Cardiovasc Interv     Publication Date:  2009 Jun 
Date Detail:
Created Date:  2009-06-22     Completed Date:  2009-08-27     Revised Date:  2014-09-05    
Medline Journal Info:
Nlm Unique ID:  101467004     Medline TA:  JACC Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  542-9     Citation Subset:  IM    
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MeSH Terms
Angioplasty, Balloon, Coronary / adverse effects*,  instrumentation,  mortality
Databases as Topic
Drug-Eluting Stents / adverse effects*
Logistic Models
Middle Aged
Myocardial Infarction / etiology*,  mortality
Retrospective Studies
Risk Assessment
Risk Factors
Surgical Procedures, Operative / adverse effects*,  mortality
Thrombosis / etiology*,  mortality
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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