BJA Advance Access published online on May 2, 2006
British Journal of Anaesthesia, doi:10.1093/bja/ael083
1 Department of Anaesthesiology and Intensive Care Medicine, Medical University of Graz, Austria
* To whom correspondence should be addressed. 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.
Accepted March 7, 2006
Clinical Investigation
Coronary artery stenting and non-cardiac surgery--a prospective outcome study
M. N. Vicenzi 1 *,
T. Meislitzer 1,
B. Heitzinger 2,
M. Halaj 3,
L. A. Fleisher 4,
and
H. Metzler 1
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
M. N. Vicenzi, E-mail: martin.vicenzi{at}meduni-graz.at
Abstract 
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.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. D. O'Connor, A. J. Taylor, E. C. Williams, and T. C. Winter Coagulation Concepts Update Am. J. Roentgenol., December 1, 2009; 193(6): 1656 - 1664. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society for Vascular Medicine, Society for Vascular Surgery, L. A. Fleisher, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery J. Am. Coll. Cardiol., November 24, 2009; 54(22): e13 - e118. [Full Text] [PDF]
|
|
|
|
 |
|
 2007 WRITING COMMITTEE MEMBERS, L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, et al. 2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Circulation, November 24, 2009; 120(21): e169 - e276. [Full Text] [PDF]
|
|
|
|
 |
|
 L Carmignani and S Picozzi Non-cardiac surgery and antiplatelet therapy following coronary artery stenting Heart, September 15, 2009; 95(18): 1537 - 1537. [Full Text] [PDF]
|
|
|
|
|
|
M Luckie, R S Khattar, and D Fraser Non-cardiac surgery and antiplatelet therapy following coronary artery stenting Heart, August 15, 2009; 95(16): 1303 - 1308. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Ormiston and P. W.S. Serruys Bioabsorbable Coronary Stents Circ Cardiovasc Interv, June 1, 2009; 2(3): 255 - 260. [Full Text] [PDF]
|
|
|
|
|
|
A. C.Y. To, G. Armstrong, I. Zeng, and M. W.I. Webster Noncardiac Surgery and Bleeding After Percutaneous Coronary Intervention Circ Cardiovasc Interv, June 1, 2009; 2(3): 213 - 221. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Evans and R. G. Davies A new type of coronary artery stent Br. J. Anaesth., March 1, 2009; 102(3): 435 - 436. [Full Text] [PDF]
|
|
|
|
|
|
D. K. Tempe, G. Godet, and (on behalf of the authors) Drug-eluting stent thrombosis in patients undergoing non-cardiac surgery Br. J. Anaesth., August 1, 2008; 101(2): 282 - 282. [Full Text] [PDF]
|
|
|
|
 |
|
 L. T. Newsome, R. S. Weller, J. C. Gerancher, M. A. Kutcher, and R. L. Royster Coronary Artery Stents: II. Perioperative Considerations and Management Anesth. Analg., August 1, 2008; 107(2): 570 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. D. Douketis, P. B. Berger, A. S. Dunn, A. K. Jaffer, A. C. Spyropoulos, R. C. Becker, and J. Ansell The Perioperative Management of Antithrombotic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 299S - 339S. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Godet, Y. Le Manach, F. Lesache, S. Perbet, and P. Coriat Drug-eluting stent thrombosis in patients undergoing non-cardiac surgery: is it always a problem? Br. J. Anaesth., April 1, 2008; 100(4): 472 - 477. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Rao, R. D. L. Stanbridge, J. Chikwe, J. Pepper, P. Skapinakis, O. Aziz, A. Darzi, and T. Athanasiou Does Previous Percutaneous Coronary Stenting Compromise the Long-Term Efficacy of Subsequent Coronary Artery Bypass Surgery? A Microsimulation Study Ann. Thorac. Surg., February 1, 2008; 85(2): 501 - 507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Developed in Collaboration With the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery J. Am. Coll. Cardiol., October 23, 2007; 50(17): e159 - e242. [Full Text] [PDF]
|
|
|
|
|
|
S. Windecker and B. Meier Late Coronary Stent Thrombosis Circulation, October 23, 2007; 116(17): 1952 - 1965. [Full Text] [PDF]
|
|
|
|
|
|
L. A. Fleisher, J. A. Beckman, K. A. Brown, H. Calkins, E. L. Chaikof, K. E. Fleischmann, W. K. Freeman, J. B. Froehlich, E. K. Kasper, J. R. Kersten, et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery) Circulation, October 23, 2007; 116(17): e418 - e500. [Full Text] [PDF]
|
|
|
|
|
|
J. W. Riddell, L. Chiche, B. Plaud, and M. Hamon Coronary Stents and Noncardiac Surgery Circulation, October 16, 2007; 116(16): e378 - e382. [Full Text] [PDF]
|
|
|
|
|
|
P.-G. Chassot, A. Delabays, and D. R. Spahn Perioperative antiplatelet therapy: the case for continuing therapy in patients at risk of myocardial infarction Br. J. Anaesth., September 1, 2007; 99(3): 316 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. L. Cohn and G. W. Smetana Update in Perioperative Medicine Ann Intern Med, August 21, 2007; 147(4): 263 - 270. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Thielmann, M. Neuhauser, S. Knipp, E. Kottenberg-Assenmacher, A. Marr, N. Pizanis, M. Hartmann, M. Kamler, P. Massoudy, and H. Jakob Prognostic impact of previous percutaneous coronary intervention in patients with diabetes mellitus and triple-vessel disease undergoing coronary artery bypass surgery J. Thorac. Cardiovasc. Surg., August 1, 2007; 134(2): 470 - 476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Harrington and M. T. Munekata Update in General Internal Medicine Ann Intern Med, July 17, 2007; 147(2): 104 - 116. [Full Text] [PDF]
|
|
|
|
|
|
E. S. Brilakis, S. Banerjee, and P. B. Berger Perioperative Management of Patients With Coronary Stents J. Am. Coll. Cardiol., June 5, 2007; 49(22): 2145 - 2150. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Howard-Alpe, J. de Bono, L. Hudsmith, W. P. Orr, P. Foex, and J. W. Sear Coronary artery stents and non-cardiac surgery Br. J. Anaesth., May 1, 2007; 98(5): 560 - 574. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Albaladejo, E. Marret, V. Piriou, and C.-M. Samama Perioperative management of antiplatelet agents in patients with coronary stents: recommendations of a French Task Force. Br. J. Anaesth., October 1, 2006; 97(4): 580 - 582. [Full Text] [PDF]
|
|
|
|
|
|
H. Dent, Z. Lekic, and M. Vicenzi Unfractionated heparin and coronary artery stenting. Br. J. Anaesth., October 1, 2006; 97(4): 582 - 582. [Full Text] [PDF]
|
|
|
|
|
|
D. R. Spahn, S. J. Howell, A. Delabays, and P.-G. Chassot Coronary stents and perioperative anti-platelet regimen: dilemma of bleeding and stent thrombosis. Br. J. Anaesth., June 1, 2006; 96(6): 675 - 677. [Full Text] [PDF]
|
|
E-letters:
Read all E-letters
- Unfractionated heparin and coronary artery stenting
- Howard Dent, et al.
- British Journal of Anaesthesia, 27 Jun 2006 [Full text]
- Re: Unfractionated heparin and coronary artery stenting
- Martin N Vicenzi
- British Journal of Anaesthesia, 13 Jul 2006 [Full text]
- Patient and stent characteristics may important for antiplatelet therapy discontinuation
- Ashish Aneja
- British Journal of Anaesthesia, 8 Aug 2006 [Full text]
- Risk of surgery after coronary stent replacement
- Emmanouil S. Brilakis
- British Journal of Anaesthesia, 8 Aug 2006 [Full text]