Faculty Collaboration Database

Characterization of post-operative risk associated with prior drug-eluting stent use. JACC Cardiovasc Interv 2009 Jun;2(6):542-9

Date

06/23/2009

Pubmed ID

19539259

DOI

10.1016/j.jcin.2009.03.014

Scopus ID

2-s2.0-66949155358 (requires institutional sign-in at Scopus site)   76 Citations

Abstract

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.

Author List

Anwaruddin S, Askari AT, Saudye H, Batizy L, Houghtaling PL, Alamoudi M, Militello M, Muhammad K, Kapadia S, Ellis SG

Author

Saif Anwaruddin MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Angioplasty, Balloon, Coronary
Databases as Topic
Drug-Eluting Stents
Female
Humans
Logistic Models
Male
Middle Aged
Myocardial Infarction
Retrospective Studies
Risk Assessment
Risk Factors
Surgical Procedures, Operative
Thrombosis
Time Factors