Key result
Elective noncardiac surgery <45 days after stent insertion had high 30-day adverse cardiac event rates, 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.
Answers are grounded in this paper and cite their sources.
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, which decreased at longer intervals.
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