title: Risk of Adverse Cardiac and Bleeding Events Following Cardiac and Noncardiac Surgery in Patients With Coronary Stent: How Important Is the Interplay Between Stent Type and Time From Stenting to Surgery?
abstract: BACKGROUND
  Epidemiology and consequences of surgery in patients with coronary stents are not clearly defined, as well as the impact of different stent types in relationship with timing of surgery.
  
  
  RESULTS
  Among 39 362 patients with previous coronary stenting enrolled in a multicenter prospective registry and followed for 5 years, 13 128 patients underwent 17 226 surgical procedures. The cumulative incidence of surgery at 30 days, 6 months, 1 year, and 5 years was 3.6%, 9.4%, 14.3%, and 40.0%, respectively, and of cardiac and noncardiac surgery was 0.8%, 2.1%, 2.6%, and 4.0% and 1.3%, 5.1%, 9.1%, and 31.7%, respectively. We assessed the incidence and the predictors of cardiac death, myocardial infarction, and serious bleeding event within 30 days from surgery. Cardiac death occurred in 438 patients (2.5%), myocardial infarction in 256 (1.5%), and serious bleeding event in 1099 (6.4%). Surgery increased 1.58× the risk of cardiac death during follow-up. Along with other risk factors, the interplay between stent type and time from percutaneous coronary intervention to surgery was independently associated with cardiac death/myocardial infarction. In comparison with bare-metal stent implanted >12 months before surgery, old-generation drug-eluting stent was associated with higher risk of events at any time point. Conversely, new-generation drug-eluting stent showed similar safety as bare-metal stent >12 months and between 6 and 12 months and appeared trendly safer between 0 and 6 months.
  
  
  CONCLUSIONS
  Surgery is frequent in patients with coronary stents and carries a considerable risk of ischemic and bleeding events. Ischemic risk is inversely related with time from percutaneous coronary intervention to surgery and is influenced by stent type.
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.). francescosaia@hotmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Laura Maria Beatrice
authors.initials: LM
authors.lastname: Belotti
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Paolo
authors.initials: P
authors.lastname: Guastaroba
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Alessandra
authors.initials: A
authors.lastname: Berardini
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Gianluca
authors.initials: G
authors.lastname: Campo
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Guiducci
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Fabio
authors.initials: F
authors.lastname: Tarantino
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Alberto
authors.initials: A
authors.lastname: Menozzi
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Varani
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Andrea
authors.initials: A
authors.lastname: Santarelli
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Stefano
authors.initials: S
authors.lastname: Tondi
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Rossana
authors.initials: R
authors.lastname: De Palma
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.affiliation: From the Institute of Cardiology, Cardio-thoraco-vascular Department, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy (F.S., A.B., C.R., A. Marzocchi); Regional Health Care and Social Agency, Bologna, Italy (L.M.B.B., P.G., R.D.P.); Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy (R.R., G.M.); Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy (G.T.); Cardiology Unit, Department of Medical Sciences, Azienda Ospedaliero-Universitaria S.Anna, Cona (Ferrara), Italy (G.C.); Interventional Cardiology Unit, S. Maria Nuova Hospital, Reggio Emilia, Italy (V.G.); Interventional Cardiology Unit, Morgagni Hospital, Forlì, Italy (F.T.); Cardiovascular Department, Maggiore Hospital, Parma, Italy (A. Menozzi); Cardiovascular Department, S. Maria delle Croci Hospital, Ravenna, Italy (E.V.); Cardiology department, Ospedale degli Infermi, Rimini, Italy (A.S.); and Department of Cardiology, Baggiovara Hospital, Modena, Italy (S.T.).
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000401:mortality / Q000628:therapy; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology*; D062645:Percutaneous Coronary Intervention; D011474:Prosthesis Design; D012042:Registries; D015607:Stents / Q000009:adverse effects*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: bleeding; drug-eluting stent; risk stratification; stent thrombosis; surgery