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ACP Journal Club |16 June 2015

Noncardiac surgery ≤ 2 y after coronary stent placement was linked to perioperative MI and all-cause mortality

Shashank S. Sinha, MD; Kim A. Eagle, MD

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Holcomb CN, Graham LA, Richman JS, et al. The incremental risk of noncardiac surgery on adverse cardiac events following coronary stenting. J Am Coll Cardiol. 2014;64:2730-9. 25541124

Cardiology:

In patients who had coronary stent implantation, is subsequent noncardiac surgery associated with increased risk for perioperative adverse cardiac events?
Retrospective cohort study using data from national Veterans Affairs (VA) and Medicaid and Medicare databases, with 30-day follow-up after noncardiac surgery and equivalent follow-up after stent placement in a cohort of matched, nonsurgical patients.
USA.
20 590 patients (median age 63 y, 98% men) who had coronary stent implantation, identified by International Classification of Diseases codes, at a VA medical center between Oct 1999 and Sep 2009, and noncardiac surgery, identified by Current Procedural Terminology codes, ≤ 2 years later (surgery cohort). Each patient in the surgery cohort was matched with 2 patients who did not have surgery ≤ 2 years after stent implantation and were alive at the time of surgery in the matched patient (n = 41 180). Matching was based on age, race, year of stent placement, stent type (bare metal [BMS] or drug-eluting [DES]), variables from the revised Cardiac Risk Index, and other previously identified predictors* of major adverse cardiac events, including myocardial infarction (MI) ≤ 6 mo before stent implantation and peripheral vascular disease. Patients who had surgery ≤ 2 weeks after coronary stent implantation were excluded.
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Sinha SS, Eagle KA. Noncardiac surgery ≤ 2 y after coronary stent placement was linked to perioperative MI and all-cause mortality. Ann Intern Med. ;162:JC11. doi: 10.7326/ACPJC-2015-162-12-011

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Published: Ann Intern Med. 2015;162(12):JC11.

DOI: 10.7326/ACPJC-2015-162-12-011

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