Coronary stent implantation and adverse cardiac events after surgery

BACKGROUND: In the risk-assessment of patients considered for non-cardiac surgery and with recent coronary stent implantation, coronary drug-eluting stent implantation procedure characteristics may be taken into account. We aimed to evaluate associations between coronary drug-eluting stent implantation procedure characteristics and the risk of myocardial infarction and all-cause death within 30 days after non-cardiac surgery.

DESIGN: Patients with coronary drug-eluting stents were identified using the Western Denmark Heart Registry. Surgical procedures performed after stent implantation were detected using the Danish National Patient Registry. We used registry based detection of myocardial infarction and all-cause death.

RESULTS: Of 22,590 patients treated with drug-eluting stents between 2005 and 2012, 4,046 underwent non-cardiac surgery within 1 and 12 months after stent implantation. We found no significant association between the risk of myocardial infarction or all-cause death within 30 days after surgery and number of arteries treated (1 (reference) versus more), number of lesions treated (1 (reference) versus more), segments treated (left main and proximal left anterior descending artery versus other (reference), total stent length (< 20mm (reference) versus ≥20mm), number of stents (1 (reference) versus >1), and largest balloon diameter (≥3mm (reference) versus <3mm). All-cause death, but not myocardial infarction, risk was lower among patients treated with first generation versus second generation stents (odds ratio 0.58).

CONCLUSIONS: We identified no significant associations between stent implantation procedure characteristics and risk of myocardial infarction or all-cause death among patients undergoing non-cardiac surgery. All-cause death was lower with first versus second generation drug eluting stents. This article is protected by copyright. All rights reserved.