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Risk of Elective Major Non-Cardiac Surgery After Coronary Stent Insertion: A Population-Based Study.
MedLine Citation:
PMID:  22893606     Owner:  NLM     Status:  Publisher    
BACKGROUND: Guidelines recommend that non-cardiac surgery be delayed until 30 to 45 days after bare-metal stent implantation and one-year after drug-eluting stent implantation. METHODS AND RESULTS: We used linked registry data and population-based administrative healthcare databases to conduct a cohort study of 8116 patients (≥40 years) who underwent major elective non-cardiac surgery in Ontario, Canada between 2003 and 2009, and received coronary stents within 10 years before surgery. Approximately 34% (n=2725) underwent stent insertion within two years before surgery, of whom 905 (33%) received drug-eluting stents. For comparison, we assembled a separate cohort of 341,350 surgical patients who had not undergone coronary revascularization. The primary outcome was 30-day major adverse cardiac events (mortality, readmission for acute coronary syndrome or repeat coronary revascularization). The overall rate of 30-day events in patients with coronary stents was 2.1% (n=170). When the interval between stent insertion and surgery was less than 45-days, event rates were high for bare-metal (6.7%) and drug-eluting (20.0%) stents. When the interval was 45 to 180 days, the event rate for bare-metal stents was 2.6%, approaching that of intermediate-risk non-revascularized individuals. Adjusted analyses suggested that event rates were increased if this interval exceeded 180 days. For drug-eluting stents, the event rate was 1.2% once the interval exceeded 180 days, approaching that of intermediate-risk non-revascularized individuals. CONCLUSIONS: The earliest optimal time for elective surgery is 46 to 180 days after bare-metal stent implantation or more than 180 days after drug-eluting stent implantation.
Duminda N Wijeysundera; Harindra C Wijeysundera; Lingsong Yun; Marcin Wasowicz; W Scott Beattie; James L Velianou; Dennis T Ko
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-14
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 St. Michael's Hosp; Toronto Gen Hosp and Univ of Toronto; ICES, Toronto, Canada;
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