title: Influence of initial acute myocardial infarction presentation on the outcome of surgical procedures after coronary stent implantation: a report from the CREDO-Kyoto PCI/CABG Registry Cohort-2.
abstract: Several previous publications have consistently reported that surgical procedures performed early after coronary stenting were associated with significantly higher risk for ischemic events than those performed late. In the current post hoc analysis of the Coronary REvascularization Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting Registry Cohort-2, we compared the outcomes of early (within 42 days) versus late surgery (beyond 42 days) after coronary stenting stratified by the initial clinical presentations [acute myocardial infarction (AMI) [early N = 153, and late N = 586] and non-AMI (early N = 202, and late N = 1457)]. Cumulative incidence of death/myocardial infarction/stent thrombosis at 30 days after surgery was significantly higher in the early group than in the late group in the AMI stratum [18.4 vs. 2.6 %, P < 0.0001, and adjusted HR 5.65 (95 % CI 2.42-13.5), P < 0.0001], but not in the non-AMI stratum [3.0 vs. 1.8 %, P = 0.3, and adjusted HR 1.52 (95 % CI 0.47-4.17), P = 0.5]. There was a significant interaction for the risk of ischemic events between the clinical presentation and the timing of surgery (P interaction = 0.03). Deaths in patients with early surgery in the AMI stratum were mostly related to preoperative complications of AMI (76 %), but not related to perioperative stent-related complications (4.0 %). In conclusion, significantly higher risk of early versus late surgery for perioperative ischemic events was seen only in patients with initial AMI presentation, but not in patients with non-AMI presentation. Previous observations suggesting higher risk in early surgery might not be related to the timing after stent implantation per se, but related to more morbid preoperative conditions in patients who underwent early surgery.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tokushige
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Koh
authors.initials: K
authors.lastname: Ono
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Masashi
authors.initials: M
authors.lastname: Iwabuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Tada
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hayano
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hamasaki
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000601:surgery; D012042:Registries; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome