TY - JOUR
T1 - Frequency of major noncardiac surgery and subsequent adverse events in the year after drug-eluting stent placement
T2 - Results from the EVENT (evaluation of drug-eluting stents and ischemic events) registry
AU - Berger, Peter B.
AU - Kleiman, Neal S.
AU - Pencina, Michael J.
AU - Hsieh, Wen Hua
AU - Steinhubl, Steven R.
AU - Jeremias, Allen
AU - Sonel, Ali
AU - Browne, Kevin
AU - Barseness, Greg
AU - Cohen, David J.
N1 - Funding Information:
Dr. Berger's Council on Medical Education–approved scientific symposia have been supported by Bristol-Myers Squibb/Sanofi-Aventis , The Medicines Company , AstraZeneca , Medtronic , Eli Lilly/Daiichi-Sankyo . He has received research funding from Thrombovision , Helena , Accumetrics , AstraZeneca , Haemoscope , The Medicines Company , Corgenix/Aspirinworks , and Eli Lilly/Daiichi-Sankyo and has been a consultant to Accumetrics, The Medicines Company, Novartis/Portola, Guerbet, PlaCor, Eli Lilly/Daiichi-Sankyo; and he owns equity in Lumen Inc. (a company that is developing an embolic protection device). Dr. Kleiman has received research grants from Sanofi-Aventis , Cordis , Eli Lilly , and Schering-Plough . Dr. Pencina is a consultant with Harvard Clinical Research Institute which works with numerous industry clients and serves on DSMB of device/drug trials. Dr. Steinhubl is an employee with stock options of The Medicines Company. He has received research support from Regado Biosciences , The Medicines Company , and Eli Lilly/Daiichi Sankyo ; and honoraria for serving on the advisory boards of Sanofi-Aventis/Bristol-Myers Squibb, Eli Lilly/Daiichi Sankyo, Cardax Pharmaceuticals, Portola Pharmaceuticals, and AstraZeneca. Dr. Cohen has received research grant support from Boston Scientific and Abbott Vascular and has received consulting fees from Cordis, Medtronic, Inc., and Eli Lilly.
PY - 2010/9
Y1 - 2010/9
N2 - Objectives This study sought to determine the frequency of noncardiac surgery and adverse post-operative events among patients who recently received a drug-eluting stent (DES) following noncardiac surgery. Background Little is known about frequency of and risks associated with noncardiac surgery after DES implantation. Methods In the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) registry, consecutive patients who underwent attempted stent placement at 42 hospitals between July 2004 and September 2005 were enrolled and followed for 1 year. In this study, we analyzed patients who received <1 DES to determine the frequency of noncardiac surgery and cardiac death, myocardial infarction, or stent thrombosis in the following week. Results Among 4,637 DES recipients, 206 (4.4%) underwent major noncardiac surgery in the following year (median days to surgery: 179 [interquartile range 112 to 266 days; range 13 to 360 days]). Overall, stent use averaged 1.5 per patient. The most frequent operations were orthopedic (36%), abdominal (31%), and vascular (20%). Compared with patients who did not undergo surgery, those who did were older, more likely to be women, and have had a prior stroke; the frequencies of prior myocardial infarction, prior coronary artery bypass graft, and diabetes were similar, as were left ventricular ejection fraction and indication for percutaneous coronary intervention. In the 7 days after surgery, 4 patients had a cardiac death, myocardial infarction, or stent thrombosis (1.9% [exact 95% confidence interval (CI): 0.5% to 4.9%]). The risk of the composite outcome was increased 27-fold in the week following noncardiac surgery compared with any other week after stent implantation (hazard ratio [HR]: 27.3 [95% CI: 10.0 to 74.2], p < 0.001). Conclusions The frequency of major noncardiac surgery in the year after DES placement is >4%. Although the overall risk of adverse outcomes was less than previously reported when surgery is performed months after DES placement, it is significantly increased in the week after major noncardiac surgery.
AB - Objectives This study sought to determine the frequency of noncardiac surgery and adverse post-operative events among patients who recently received a drug-eluting stent (DES) following noncardiac surgery. Background Little is known about frequency of and risks associated with noncardiac surgery after DES implantation. Methods In the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) registry, consecutive patients who underwent attempted stent placement at 42 hospitals between July 2004 and September 2005 were enrolled and followed for 1 year. In this study, we analyzed patients who received <1 DES to determine the frequency of noncardiac surgery and cardiac death, myocardial infarction, or stent thrombosis in the following week. Results Among 4,637 DES recipients, 206 (4.4%) underwent major noncardiac surgery in the following year (median days to surgery: 179 [interquartile range 112 to 266 days; range 13 to 360 days]). Overall, stent use averaged 1.5 per patient. The most frequent operations were orthopedic (36%), abdominal (31%), and vascular (20%). Compared with patients who did not undergo surgery, those who did were older, more likely to be women, and have had a prior stroke; the frequencies of prior myocardial infarction, prior coronary artery bypass graft, and diabetes were similar, as were left ventricular ejection fraction and indication for percutaneous coronary intervention. In the 7 days after surgery, 4 patients had a cardiac death, myocardial infarction, or stent thrombosis (1.9% [exact 95% confidence interval (CI): 0.5% to 4.9%]). The risk of the composite outcome was increased 27-fold in the week following noncardiac surgery compared with any other week after stent implantation (hazard ratio [HR]: 27.3 [95% CI: 10.0 to 74.2], p < 0.001). Conclusions The frequency of major noncardiac surgery in the year after DES placement is >4%. Although the overall risk of adverse outcomes was less than previously reported when surgery is performed months after DES placement, it is significantly increased in the week after major noncardiac surgery.
KW - adverse events
KW - drug-eluting stent
KW - noncardiac surgery
UR - http://www.scopus.com/inward/record.url?scp=77956634931&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77956634931&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2010.03.021
DO - 10.1016/j.jcin.2010.03.021
M3 - Article
C2 - 20850090
AN - SCOPUS:77956634931
VL - 3
SP - 920
EP - 927
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
SN - 1936-8798
IS - 9
ER -