Risk Associated With Surgery Within 12 Months After Coronary Drug-Eluting Stent Implantation

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• 作者：Gro Egholm ; MD ; PhD^a ; ^b ; ^grochi@rm.dk ; Steen Dalby Kristensen ; MD ; DMSc^a ; Troels Thim ; MD ; PhD^a ; Kevin K.W. Olesen ; MD^a ; Morten Madsen ; MSc^b ; Svend E. Jensen ; MD ; PhD^c ; Lisette O. Jensen ; MD ; PhD ; DMSc^d ; Henrik T. Sø ; rensen ; MD ; PhD ; DMSc^b ; Hans E. Bø ; tker ; MD ; PhD ; DMSc^a ; Michael Maeng ; MD ; PhD^a
• 关键词：coronary artery disease ; epidemiology ; interventional cardiology ; noncardiac surgery
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：20 December 2016
• 年：2016
• 卷：68
• 期：24
• 页码：2622-2632
• 全文大小：873 K
• 卷排序：68

文摘

Guidelines recommend postponing surgery for at least 6 months after treatment with a drug-eluting stent by percutaneous coronary intervention (DES-PCI).ObjectivesThe goal of this study was to evaluate the surgical risk associated with DES-PCI compared with that in nonstented patients without ischemic heart disease (IHD).MethodsBetween 2005 and 2012, a total of 22,590 patients underwent DES-PCI in western Denmark. By record-linking the Western Denmark Heart Registry and the Danish National Patient Register, we evaluated 4,303 DES-PCI–treated patients with a surgical procedure and compared them with a control group of patients without previous IHD undergoing similar surgical procedures (n = 20,232). Events of interest were myocardial infarction (MI), cardiac death, and all-cause mortality within 30 days after surgery.ResultsSurgery in DES-PCI–treated patients was associated with an increased risk of MI (1.6% vs. 0.2%; odds ratio [OR]: 4.82; 95% confidence interval [CI]: 3.25 to 7.16) and cardiac death (1.0% vs. 0.2%; OR: 5.87; 95% CI: 3.60 to 9.58) but not all-cause mortality (3.1% vs. 2.7%; OR: 1.12; 95% CI: 0.91 to 1.38). When stratified for time from PCI to surgery, only surgery within the first month was associated with a significant increased risk of events.ConclusionsPatients requiring surgery within 12 months after DES-PCI had an increased risk of MI and cardiac death compared with patients without IHD. The increased risk was only present within the first month after DES-PCI, suggesting that surgery might be undertaken earlier than currently recommended.