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Study Examines Surgery Risks In Stented Patients

Thu, 10/10/2013 - 11:31am
Todd Neale

In patients who had received a stent, the factors most strongly associated with major adverse cardiac events (MACE) following noncardiac surgery included a nonelective indication, a history of recent myocardial infarction (MI), and an elevated cardiac risk, researchers found...

In an adjusted model, the three strongest predictors of MACE were nonelective surgery (OR 4.77, 95% CI 4.07-5.59), a history of MI in the 6 months before surgery (OR 2.63, 95% CI 2.32-2.98), and a revised cardiac risk index indicating at least a moderate level of risk at the time of surgery (OR 2.13, 95% CI 1.85-2.44), according to Mary Hawn, MD, MPH, of the University of Alabama at Birmingham, and colleagues.

The timing of the operation relative to when the stent was implanted was a weaker predictor, and the stent type -- drug-eluting versus bare-metal -- was not significantly associated with adverse events at all. In addition, whether antiplatelet therapy was stopped or continued was not related to the likelihood of having a MACE after surgery, the researchers reported online in the Journal of the American Medical Association.

The results were presented simultaneously at the American College of Surgeons meeting in Washington.

"The present findings suggest that underlying surgical and cardiac risk, rather than stent type, are the primary factors associated with perioperative MACE, that event rates stabilize by 6 months, and that antiplatelet therapy continuation does not substantially mitigate risk," Hawn and colleagues wrote.

"Accordingly, the current focus of the guidelines on differential timing recommendations by stent type may warrant reconsideration, and greater concentration may need to be placed on assessing and optimizing cardiac risk," they wrote, acknowledging that the observational study design renders the findings hypothesis-generating only.

About one out of every five patients who receive a stent will need a noncardiac operation within 2 years, and questions remain about how long to wait until performing surgery after implantation and whether to continue antiplatelet therapy.

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