Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention.
BACKGROUND
The duration of time that elective noncardiac surgery (NCS) should be delayed after percutaneous coronary intervention (PCI) with bare metal stents (BMSs) is unknown.


METHODS
This large, single-center, retrospective study examined the relation between complication rate in patients with BMSs undergoing NCS and the duration of time between PCI and NCS. Primary endpoints included in-hospital major adverse cardiac events (death, myocardial infarction, stent thrombosis, or repeat revascularization with either coronary artery bypass grafting or PCI of the target vessel) and bleeding events. The relation between the events and the timing of noncardiac surgery after PCI with BMS was assessed using univariate analysis and multiple logistic regression.


RESULTS
From January 1, 1990, to January 1, 2005, a total of 899 patients were identified. The frequency of major adverse cardiac events was 10.5% when NCS was performed less than 30 days after PCI with BMS, 3.8% when NCS was performed between 31 and 90 days after PCI with BMS, and 2.8% when NCS was performed more than 90 days after PCI with BMS. In univariate and multivariate analyses, a shorter time interval between PCI with BMS and noncardiac surgery was significantly associated with increased incidence of major adverse cardiac events (univariate: P < 0.001; odds ratio = 4.0; 95% confidence interval, 2.0-8.3; multivariate: P = 0.006; odds ratio = 3.2; 95% confidence interval, 1.5-6.9). Bleeding events were not associated with time between PCI with BMS and NCS or with the use of antiplatelet therapy in the week before NCS.


CONCLUSIONS
The incidence of major adverse cardiac events is lowest when NCS is performed at least 90 days after PCI with BMS.
Nuttall
Gregory A
GA
Department of Anesthesiology, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905, USA. nuttall.gregory@mayo.edu
Brown
Michael J
MJ
Stombaugh
John W
JW
Michon
Peter B
PB
Hathaway
Matthew F
MF
Lindeen
Kevin C
KC
Hanson
Andrew C
AC
Schroeder
Darrell R
DR
Oliver
William C
WC
Holmes
David R
DR
Rihal
Charanjit S
CS
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D015607:Stents / Q000009:adverse effects*; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013997:Time Factors
D008670:Metals; D010975:Platelet Aggregation Inhibitors