Coronary artery stenting and non-cardiac surgery - A prospective outcome study

Martin N. Vicenzi, T. Meislitzer, B. Heitzinger, M. Halaj, L. A. Fleisher, H. Metzler

Research output: Contribution to journalArticlepeer-review

Abstract

Background. A 45% complication rate and a mortality of 20% were reported previously in patients undergoing non-cardiac surgery after coronary artery stenting. Discontinuation of antiplatelet drugs appeared to be of major influence on outcome. Therefore we undertook a prospective, observational multicentre study with predefined heparin therapy and antiplatelet medication in patients undergoing non-cardiac procedures after coronary artery stenting. Methods. One hundred and three patients from three medical institutions were enrolled prospectively. Patients received coronary artery stents within 1 yr before non-cardiac surgery (urgent, semi-urgent or elective). Antiplatelet drug therapy was not, or only briefly, interrupted. Heparin was administered to all patients. All patients were on an intensive/intermediate care unit after surgery. Main outcome was the combined (cardiac, bleeding, surgical, sepsis) complication rate. Results. Of 103 patients, 44.7% (95% CI 34.9-54.8) suffered complications after surgery; 4.9% (95% CI 1.6-11.0) of the patients died. All but two (bleeding only) adverse events were of cardiac nature. The majority of complications occurred early after surgery. The risk of suffering an event was 2.11-fold greater in patients with recent stents (<35 days before surgery) as compared with percutaneous cardiac intervention more than 90 days before surgery. Conclusions. Despite heparin and despite having all patients on intensive/intermediate care units, cardiac events are the major cause for new perioperative morbidity/mortality in patients undergoing non-cardiac surgery after coronary artery stenting. The complication rate exceeds the re-occlusion rate of stents in patients without surgery (usually <1% annually). Patients with coronary artery stenting less than 35 days before surgery are at the greatest risk.

Original languageEnglish (US)
Pages (from-to)686-693
Number of pages8
JournalBritish journal of anaesthesia
Volume96
Issue number6
DOIs
StatePublished - Jun 2006

Keywords

  • Complications, stent thrombosis
  • Procedure, percutaneous coronary intervention (PCI)
  • Risk, perioperative

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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