Risk factors for cardiovascular events and bleeding complications following non-cardiac surgery or procedure in patients with drug eluting stent placement.
OBJECTIVE
Previous studies suggest an increased incidence of cardiovascular (CV) events after P2Y12 receptor blocker cessation. The aim of this study was to examine the effect of P2Y12 receptor blocker cessation and other risk factors on the risk of CV events and bleeding events after non-cardiac surgery/procedure in patients with drug-eluting stents (DES).


METHODS
Retrospective cohort study.


METHODS
Single large healthcare system in the northeast of the USA.


METHODS
All adult patients who had a coronary drug eluting stent (DES) placed between 2002 and 2007 in our institution.


METHODS
No randomised intervention. The principal exposure was cessation of P2Y12 receptor blocker.


METHODS
This was a retrospective study of all adult patients who had a coronary DES placed between 2002 and 2007 in our institution. We considered all non-cardiac procedures up to 1 year after DES placement. Generalised estimating equations were used to identify the independent risk factors. Multiple imputations were used to replace missing values.


METHODS
The outcomes were CV events including death from any cause and bleeding, occurring within 30 days after the procedure.


RESULTS
From 2002 to 2007, 6397 patients had DES, 873 (13.6%) had at least one non-cardiac procedure. A total of 3.6% (33/927) of the admissions were complicated by at least one cardiovascular event and 6.9% (55/795) were complicated by bleeding. Urgent procedure (versus elective) was the only independent risk factor for CV events (OR=4.82, 95% CI 1.95 to 11.89). Older age, diabetes, urgent procedures, orthopaedic and vascular surgery compared to unclassified surgery were independent risk factors for bleeding.


CONCLUSIONS
Non-cardiac procedures are common within 1 year after DES placement. Urgent nature of procedure is a risk factor for CV events and bleeding complications. Older age, diabetes, type of surgery, are risk factors associated only with bleeding events.
The Royal Bournemouth and Christchurch Hospitals Foundation Trusts , Bournemouth , UK.
Divya
D
Tiwari
Christiana Care Center for Outcomes Research, Christiana Care Health System , Newark, Delaware , USA.
Claudine T
CT
Jurkovitz
Christiana Care Center for Outcomes Research, Christiana Care Health System , Newark, Delaware , USA.
Zugui
Z
Zhang
Christiana Care Center for Outcomes Research, Christiana Care Health System , Newark, Delaware , USA.
James
J
Bowen
Christiana Care Center for Outcomes Research, Christiana Care Health System , Newark, Delaware , USA.
Paul
P
Kolm
AstraZeneca Pharmaceuticals LP , Wilmington, Delaware , USA.
Gail
G
Wygant
Christiana Care Center for Outcomes Research, Christiana Care Health System , Newark, Delaware , USA.
William S
WS
Weintraub
Heart Failure; Interventional Cardiology