Key result
Elective noncardiac surgery <45 days after stent insertion had high 30-day adverse cardiac event rates (6.7% bare-metal, 20.0% drug-eluting), which decreased at longer intervals.
Why the study?
Does the time interval between coronary stent insertion and elective major noncardiac surgery affect the risk of 30-day major adverse cardiac events?
Cohort (n=349,466)
Yes
Does the time interval between coronary stent insertion and elective major noncardiac surgery affect the risk of 30-day major adverse cardiac events?
Elective noncardiac surgery can be safely performed 46 to 180 days after bare-metal stent implantation or >180 days after drug-eluting stent implantation, suggesting shorter optimal wait times than historical guidelines.
May inform shorter post-stent surgery intervals than prior guidelines; leaves optimal timing open pending randomized trials.
BACKGROUND: Guidelines recommend that noncardiac surgery be delayed until 30 to 45 days after bare-metal stent implantation and 1 year after drug-eluting stent implantation. METHODS AND RESULTS: We used linked registry data and population-based administrative health care databases to conduct a cohort study of 8116 patients (≥40 years of age) who underwent major elective noncardiac 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 2 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 <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 nonrevascularized 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 nonrevascularized individuals. CONCLUSIONS: The earliest optimal time for elective surgery is 46 to 180 days after bare-metal stent implantation or >180 days after drug-eluting stent implantation.
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Wijeysundera et al. (2012) conducted a cohort in Major elective noncardiac surgery (n=349,466). Coronary stent insertion prior to surgery vs. No prior coronary revascularization was evaluated on 30-day major adverse cardiac events (mortality, readmission for acute coronary syndrome, or repeat coronary revascularization). Elective noncardiac surgery <45 days after stent insertion had high 30-day adverse cardiac event rates (6.7% bare-metal, 20.0% drug-eluting), which decreased at longer intervals.
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