Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention

Gregory A. Nuttall, Michael J. Brown, John W. Stombaugh, Peter B. Michon, Matthew F. Hathaway, Kevin C. Lindeen, Andrew C. Hanson, Darrell R. Schroeder, William C. Oliver, David Holmes, Charanjit Rihal

Research output: Contribution to journalArticle

137 Citations (Scopus)

Abstract

Background: The duration of time that elective noncardiac surgery (NCS) should be delayed after percutaneous coronary intervention (PCI) with bare metal stents (BMSs) is unknown. Methods: This large, single-center, retrospective study examined the relation between complication rate in patients with BMSs undergoing NCS and the duration of time between PCI and NCS. Primary endpoints included in-hospital major adverse cardiac events (death, myocardial infarction, stent thrombosis, or repeat revascularization with either coronary artery bypass grafting or PCI of the target vessel) and bleeding events. The relation between the events and the timing of noncardiac surgery after PCI with BMS was assessed using univariate analysis and multiple logistic regression. Results: From January 1, 1990, to January 1, 2005, a total of 899 patients were identified. The frequency of major adverse cardiac events was 10.5% when NCS was performed less than 30 days after PCI with BMS, 3.8% when NCS was performed between 31 and 90 days after PCI with BMS, and 2.8% when NCS was performed more than 90 days after PCI with BMS. In univariate and multivariate analyses, a shorter time interval between PCI with BMS and noncardiac surgery was significantly associated with increased incidence of major adverse cardiac events (univariate: P < 0.001; odds ratio = 4.0; 95% confidence interval, 2.0-8.3; multivariate: P = 0.006; odds ratio = 3.2; 95% confidence interval, 1.5-6.9). Bleeding events were not associated with time between PCI with BMS and NCS or with the use of antiplatelet therapy in the week before NCS. Conclusions: The incidence of major adverse cardiac events is lowest when NCS is performed at least 90 days after PCI with BMS.

Original languageEnglish (US)
Pages (from-to)588-595
Number of pages8
JournalAnesthesiology
Volume109
Issue number4
DOIs
StatePublished - Oct 2008
Externally publishedYes

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Percutaneous Coronary Intervention
Thoracic Surgery
Stents
Metals
Odds Ratio
Confidence Intervals
Hemorrhage
Incidence
Coronary Artery Bypass
Thrombosis
Multivariate Analysis
Retrospective Studies
Logistic Models
Myocardial Infarction

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Nuttall, G. A., Brown, M. J., Stombaugh, J. W., Michon, P. B., Hathaway, M. F., Lindeen, K. C., ... Rihal, C. (2008). Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention. Anesthesiology, 109(4), 588-595. https://doi.org/10.1097/ALN.0b013e318186ddf8

Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention. / Nuttall, Gregory A.; Brown, Michael J.; Stombaugh, John W.; Michon, Peter B.; Hathaway, Matthew F.; Lindeen, Kevin C.; Hanson, Andrew C.; Schroeder, Darrell R.; Oliver, William C.; Holmes, David; Rihal, Charanjit.

In: Anesthesiology, Vol. 109, No. 4, 10.2008, p. 588-595.

Research output: Contribution to journalArticle

Nuttall, GA, Brown, MJ, Stombaugh, JW, Michon, PB, Hathaway, MF, Lindeen, KC, Hanson, AC, Schroeder, DR, Oliver, WC, Holmes, D & Rihal, C 2008, 'Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention', Anesthesiology, vol. 109, no. 4, pp. 588-595. https://doi.org/10.1097/ALN.0b013e318186ddf8
Nuttall GA, Brown MJ, Stombaugh JW, Michon PB, Hathaway MF, Lindeen KC et al. Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention. Anesthesiology. 2008 Oct;109(4):588-595. https://doi.org/10.1097/ALN.0b013e318186ddf8
Nuttall, Gregory A. ; Brown, Michael J. ; Stombaugh, John W. ; Michon, Peter B. ; Hathaway, Matthew F. ; Lindeen, Kevin C. ; Hanson, Andrew C. ; Schroeder, Darrell R. ; Oliver, William C. ; Holmes, David ; Rihal, Charanjit. / Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention. In: Anesthesiology. 2008 ; Vol. 109, No. 4. pp. 588-595.
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abstract = "Background: The duration of time that elective noncardiac surgery (NCS) should be delayed after percutaneous coronary intervention (PCI) with bare metal stents (BMSs) is unknown. Methods: This large, single-center, retrospective study examined the relation between complication rate in patients with BMSs undergoing NCS and the duration of time between PCI and NCS. Primary endpoints included in-hospital major adverse cardiac events (death, myocardial infarction, stent thrombosis, or repeat revascularization with either coronary artery bypass grafting or PCI of the target vessel) and bleeding events. The relation between the events and the timing of noncardiac surgery after PCI with BMS was assessed using univariate analysis and multiple logistic regression. Results: From January 1, 1990, to January 1, 2005, a total of 899 patients were identified. The frequency of major adverse cardiac events was 10.5{\%} when NCS was performed less than 30 days after PCI with BMS, 3.8{\%} when NCS was performed between 31 and 90 days after PCI with BMS, and 2.8{\%} when NCS was performed more than 90 days after PCI with BMS. In univariate and multivariate analyses, a shorter time interval between PCI with BMS and noncardiac surgery was significantly associated with increased incidence of major adverse cardiac events (univariate: P < 0.001; odds ratio = 4.0; 95{\%} confidence interval, 2.0-8.3; multivariate: P = 0.006; odds ratio = 3.2; 95{\%} confidence interval, 1.5-6.9). Bleeding events were not associated with time between PCI with BMS and NCS or with the use of antiplatelet therapy in the week before NCS. Conclusions: The incidence of major adverse cardiac events is lowest when NCS is performed at least 90 days after PCI with BMS.",
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T1 - Time and cardiac risk of surgery after bare-metal stent percutaneous coronary intervention

AU - Nuttall, Gregory A.

AU - Brown, Michael J.

AU - Stombaugh, John W.

AU - Michon, Peter B.

AU - Hathaway, Matthew F.

AU - Lindeen, Kevin C.

AU - Hanson, Andrew C.

AU - Schroeder, Darrell R.

AU - Oliver, William C.

AU - Holmes, David

AU - Rihal, Charanjit

PY - 2008/10

Y1 - 2008/10

N2 - Background: The duration of time that elective noncardiac surgery (NCS) should be delayed after percutaneous coronary intervention (PCI) with bare metal stents (BMSs) is unknown. Methods: This large, single-center, retrospective study examined the relation between complication rate in patients with BMSs undergoing NCS and the duration of time between PCI and NCS. Primary endpoints included in-hospital major adverse cardiac events (death, myocardial infarction, stent thrombosis, or repeat revascularization with either coronary artery bypass grafting or PCI of the target vessel) and bleeding events. The relation between the events and the timing of noncardiac surgery after PCI with BMS was assessed using univariate analysis and multiple logistic regression. Results: From January 1, 1990, to January 1, 2005, a total of 899 patients were identified. The frequency of major adverse cardiac events was 10.5% when NCS was performed less than 30 days after PCI with BMS, 3.8% when NCS was performed between 31 and 90 days after PCI with BMS, and 2.8% when NCS was performed more than 90 days after PCI with BMS. In univariate and multivariate analyses, a shorter time interval between PCI with BMS and noncardiac surgery was significantly associated with increased incidence of major adverse cardiac events (univariate: P < 0.001; odds ratio = 4.0; 95% confidence interval, 2.0-8.3; multivariate: P = 0.006; odds ratio = 3.2; 95% confidence interval, 1.5-6.9). Bleeding events were not associated with time between PCI with BMS and NCS or with the use of antiplatelet therapy in the week before NCS. Conclusions: The incidence of major adverse cardiac events is lowest when NCS is performed at least 90 days after PCI with BMS.

AB - Background: The duration of time that elective noncardiac surgery (NCS) should be delayed after percutaneous coronary intervention (PCI) with bare metal stents (BMSs) is unknown. Methods: This large, single-center, retrospective study examined the relation between complication rate in patients with BMSs undergoing NCS and the duration of time between PCI and NCS. Primary endpoints included in-hospital major adverse cardiac events (death, myocardial infarction, stent thrombosis, or repeat revascularization with either coronary artery bypass grafting or PCI of the target vessel) and bleeding events. The relation between the events and the timing of noncardiac surgery after PCI with BMS was assessed using univariate analysis and multiple logistic regression. Results: From January 1, 1990, to January 1, 2005, a total of 899 patients were identified. The frequency of major adverse cardiac events was 10.5% when NCS was performed less than 30 days after PCI with BMS, 3.8% when NCS was performed between 31 and 90 days after PCI with BMS, and 2.8% when NCS was performed more than 90 days after PCI with BMS. In univariate and multivariate analyses, a shorter time interval between PCI with BMS and noncardiac surgery was significantly associated with increased incidence of major adverse cardiac events (univariate: P < 0.001; odds ratio = 4.0; 95% confidence interval, 2.0-8.3; multivariate: P = 0.006; odds ratio = 3.2; 95% confidence interval, 1.5-6.9). Bleeding events were not associated with time between PCI with BMS and NCS or with the use of antiplatelet therapy in the week before NCS. Conclusions: The incidence of major adverse cardiac events is lowest when NCS is performed at least 90 days after PCI with BMS.

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