BJA Advance Access originally published online on May 2, 2006
British Journal of Anaesthesia 2006 96(6):686-693; doi:10.1093/bja/ael083
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Coronary artery stenting and non-cardiac surgery—a prospective outcome study
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1 Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz Austria
2 Department of Anaesthesiology and Intensive Care Medicine, General Hospital Linz Austria
3 Department of Anaesthesiology and Intensive Care Medicine, County Hospital Leoben Austria
4 Department of Anaesthesiology and Intensive Care Medicine, University of Pennsylvania Health Systems Philadelphia, USA
*Corresponding author. E-mail: martin.vicenzi{at}meduni-graz.at
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.
Preliminary, short-term results from this study were presented at the ASA Annual Meeting 2003 in San Francisco, USA.
This article is accompanied by the Editorial.
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