Frequency and risk of noncardiac surgery after drug-eluting stent implantation.
BACKGROUND
Few studies have described the frequency and risk of surgery after drug-eluting stent (DES) implantation.


METHODS
The medical records of 827 consecutive patients who received a DES at our institution between January 1, 2005 and July 1, 2008 were retrospectively reviewed to determine the outcomes of patients who subsequently underwent noncardiac surgery.


RESULTS
During a median follow-up of 21 months, 135 patients underwent 191 noncardiac surgeries. The incidence of noncardiac surgery was 7% at 1 year, 18% at 2 years, and 22% at 3 years. Mean age was 62 years and 96% were men. A perioperative complication occurred in 19 surgeries (10%): excessive bleeding in 11 patients (6%), myocardial infarction in four patients (2%), acute renal failure in one patient (0.5%), hypotension and syncope in one patient (0.5%) and postoperative death in three patients (1.6%). Stent thrombosis occurred in one patient (0.5%). A complication occurred in six of 58 surgeries (10%) in which patients received perioperative clopidogrel vs. 13 of 133 surgeries (10%) in which patients did not receive perioperative clopidogrel (P = 0.90). Complications occurred in three of 25 surgeries performed within 6 months (16%), in four of 37 surgeries performed between 6 and 12 months (11%), and in 12 of 129 surgeries performed after >12 months (9%) from DES implantation (P = 0.90).


CONCLUSIONS
Noncardiac surgery is frequently needed in the years after DES implantation and appears to carry a low risk of stent thrombosis and perioperative complications.
Gandhi
Nainesh K
NK
VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas 75216, USA.
Abdel-Karim
Abdul-Rahman R
AR
Banerjee
Subhash
S
Brilakis
Emmanouil S
ES
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D016009:Chi-Square Distribution; D000077144:Clopidogrel; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000401:mortality; D013781:Texas; D013927:Thrombosis / Q000209:etiology; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine