Patient and lesion-specific characteristics predict risk of major adverse cardiovascular events among patients with previous percutaneous coronary intervention undergoing noncardiac surgery.
OBJECTIVE
To identify predictors of major adverse cardiovascular outcomes (MACE) among patients with prior percutaneous coronary intervention (PCI) who require noncardiac surgery.


BACKGROUND
Patients with prior PCI who undergo noncardiac surgery have an increased risk of postoperative MACE, but few studies have examined the association of PCI lesion characteristics with subsequent operative risk.


METHODS
Patients were identified using the VA Clinical Assessment, Reporting, and Tracking (CART) program. Patients who underwent noncardiac surgery within 2 years after stent placement were linked to VA and non-VA surgical records. A multivariable logistic regression model was developed to identify predictors of postoperative MACE.


RESULTS
Among 12,621 patients with a history of prior PCI who underwent subsequent noncardiac surgery, 570 (4.5%) developed postoperative MACE. The median time from stent placement to surgery was 368 days (IQR 181-528). The strongest predictors of postoperative MACE were urgency of the operation, revised cardiac risk index, the indication for the prior PCI, and timing of the surgery after the PCI. Lesion characteristics independently associated with postoperative MACE included PCI to a distal (AOR 1.43, 95% CI 1.11-1.83) or ostial lesion (AOR 1.52, 95% CI 1.11-2.08), and lesion calcification (AOR 1.29, 95% CI 1.03-1.61), but stent length and target vessel were not independently associated with outcomes. Placement of a bare metal stent was also an independent predictor of MACE after noncardiac surgery (AOR 1.29, 95% CI 1.06-1.57).


CONCLUSIONS
While patient and operative characteristics are the strongest predictors of MACE after noncardiac surgery, specific lesion characteristics including ostial or distal lesion location and calcification are novel risk factors for postoperative MACE. © 2016 Wiley Periodicals, Inc.
Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
Ehrin J
EJ
Armstrong
Birmingham Veterans Administration Hospital, Birmingham, Alabama.
Laura
L
Graham
Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
Stephen W
http://orcid.org/0000-0003-0678-4873
SW
Waldo
Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
Javier A
JA
Valle
Section of Cardiology, Denver VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado.
Thomas M
TM
Maddox
Birmingham Veterans Administration Hospital, Birmingham, Alabama.|Department of Surgery, Stanford University, Stanford, California.
Mary T
MT
Hawn
D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015607:Stents; D013514:Surgical Procedures, Operative; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
operative risk; percutaneous coronary intervention; surgery