Risk of Adverse Cardiac and Bleeding Events Following Cardiac and Noncardiac Surgery in Patients With Coronary Stent : How Important Is the Interplay Between Stent Type and Time From Stenting to Surgery?

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Titel: Risk of Adverse Cardiac and Bleeding Events Following Cardiac and Noncardiac Surgery in Patients With Coronary Stent : How Important Is the Interplay Between Stent Type and Time From Stenting to Surgery? : How Important Is the Interplay Between Stent Type and Time From Stenting to Surgery?
Beteiligte: Saia, Francesco; Belotti, Laura Maria Beatrice; Guastaroba, Paolo; Berardini, Alessandra; Rossini, Roberta; Musumeci, Giuseppe; Tarantini, Giuseppe; Campo, Gianluca; Guiducci, Vincenzo; Tarantino, Fabio; Menozzi, Alberto; Varani, Elisabetta; Santarelli, Andrea; Tondi, Stefano; De Palma, Rossana; Rapezzi, Claudio; Marzocchi, Antonio
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2016
Erschienen in: Circulation: Cardiovascular Quality and Outcomes
Sprache: Englisch
DOI: 10.1161/circoutcomes.115.002155
ISSN: 1941-7713; 1941-7705
Schlagwörter: Cardiology and Cardiovascular Medicine
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Beschreibung: <jats:sec> <jats:title>Background—</jats:title> <jats:p>Epidemiology and consequences of surgery in patients with coronary stents are not clearly defined, as well as the impact of different stent types in relationship with timing of surgery.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and Results—</jats:title> <jats:p>Among 39 362 patients with previous coronary stenting enrolled in a multicenter prospective registry and followed for 5 years, 13 128 patients underwent 17 226 surgical procedures. The cumulative incidence of surgery at 30 days, 6 months, 1 year, and 5 years was 3.6%, 9.4%, 14.3%, and 40.0%, respectively, and of cardiac and noncardiac surgery was 0.8%, 2.1%, 2.6%, and 4.0% and 1.3%, 5.1%, 9.1%, and 31.7%, respectively. We assessed the incidence and the predictors of cardiac death, myocardial infarction, and serious bleeding event within 30 days from surgery. Cardiac death occurred in 438 patients (2.5%), myocardial infarction in 256 (1.5%), and serious bleeding event in 1099 (6.4%). Surgery increased 1.58× the risk of cardiac death during follow-up. Along with other risk factors, the interplay between stent type and time from percutaneous coronary intervention to surgery was independently associated with cardiac death/myocardial infarction. In comparison with bare-metal stent implanted >12 months before surgery, old-generation drug-eluting stent was associated with higher risk of events at any time point. Conversely, new-generation drug-eluting stent showed similar safety as bare-metal stent >12 months and between 6 and 12 months and appeared trendly safer between 0 and 6 months.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>Surgery is frequent in patients with coronary stents and carries a considerable risk of ischemic and bleeding events. Ischemic risk is inversely related with time from percutaneous coronary intervention to surgery and is influenced by stent type.</jats:p> </jats:sec>
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