title: Perioperative complications after noncardiac surgery in patients with insertion of second-generation drug-eluting stents.
abstract: The perioperative outcomes of noncardiac surgery in patients who have received second-generation drug-eluting stents (DESs) have received limited study. We reviewed the medical records of 1,748 consecutive patients who received DES at our institution (1,789 procedures) from January 1, 2009, to July 1, 2012, to determine the outcomes of subsequent noncardiac surgery. During a median follow-up of 43 months, 221 patients underwent 345 noncardiac surgeries (138 low risk, 130 intermediate risk, and 77 high risk), of which 278 were in patients with previous second-generation DES implantation. The incidence of noncardiac surgery in patients with previous second-generation DES implantation was 4.5% at 1 year, 11.6% at 2 years, and 15.2% at 3 years. The mean time from stent implantation to surgery was 21±12.9 months. Mean age was 66±8 years, 99% were men, and 11% had a perioperative complication, including 5.8% major bleeding, 2.5% acute kidney injury, 2.2% major adverse cardiac event, and 1.4% stroke. Perioperative stent thrombosis occurred in 2 patients (0.7%, 95% confidence interval 0.2% to 2.6%): 1 patient had received a DES 14 months before surgery and had stent thrombosis on the day of surgery and the other had a DES implanted 21 months before surgery and developed stent thrombosis the day after surgery. In conclusion, the incidence of perioperative complications with noncardiac surgery after second-generation DES implantation was 11% and consisted mainly of bleeding (5.8%). The incidence of definite stent thrombosis was 0.7%.
authors.affiliation: Department of Internal Medicine, VA North Texas Health care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Nathan
authors.initials: N
authors.lastname: Lo
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Health care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Anna
authors.initials: A
authors.lastname: Kotsia
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Health care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: George
authors.initials: G
authors.lastname: Christopoulos
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Health care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Michele
authors.initials: M
authors.lastname: Roesle
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Health care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.affiliation: Department of Anethesiology, VA North Texas Health care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Bryant J
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, VA North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Webb
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Health care System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Department of Cardiovascular Diseases, VA North Texas Health care System and University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: esbrilakis@gmail.com.
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000401:mortality; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D017202:Myocardial Ischemia / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D013514:Surgical Procedures, Operative; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome