The Incremental Risk of Coronary Stents on Postoperative Adverse Events

Holcomb, Carla N.; Graham, Laura A.; Richman, Joshua S.; Itani, Kamal M.F.; Maddox, Thomas M.; Hawn, Mary T.

doi:10.1097/sla.0000000000001246

Cited by 50 publications

(40 citation statements)

References 24 publications

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“…However, patients with stents had a higher risk of adverse cardiac events within the 30-day post-operative period. 227 The incremental risk did not vary by stent type. 227 In both studies, roughly 50% of patients underwent stenting because of ACS and no incremental risk was observed in this higher risk population as compared to stable CAD patients.…”

Section: Elective Non-cardiac Surgery In Patients On Dual Antiplatelementioning

confidence: 95%

“…227 The incremental risk did not vary by stent type. 227 In both studies, roughly 50% of patients underwent stenting because of ACS and no incremental risk was observed in this higher risk population as compared to stable CAD patients. Therefore, a minimum of 1 month of DAPT should be considered, independently of the type of implanted stent (i.e.…”

Section: Elective Non-cardiac Surgery In Patients On Dual Antiplatelementioning

confidence: 95%

“…Data for patients with coronary stents implanted in a Veterans' Administration (VA) hospital from 2000 to 2010 were also recently matched with VA Surgical Quality Improvement Program data to identify non-cardiac surgery within 24 months of stent placement. 227 Each patient with a stent(s) was matched with two surgical patients without stents on surgical characteristics and cardiac risk factors. The two groups had similar risk of adverse cardiac events during 2 years of follow-up.…”

Section: Elective Non-cardiac Surgery In Patients On Dual Antiplatelementioning

confidence: 99%

See 2 more Smart Citations

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

Valgimigli¹,

Bueno²,

Byrne³

et al. 2017

European Heart Journal

2,357

484

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Section: Elective Non-cardiac Surgery In Patients On Dual Antiplatelementioning

confidence: 95%

Section: Elective Non-cardiac Surgery In Patients On Dual Antiplatelementioning

confidence: 95%

Section: Elective Non-cardiac Surgery In Patients On Dual Antiplatelementioning

confidence: 99%

See 1 more Smart Citation

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

Valgimigli¹,

Bueno²,

Byrne³

et al. 2017

European Heart Journal

2,357

484

View full text Add to dashboard Cite

“…We compared cohorts of patients with metastatic cancer who did and did not receive chemotherapy, matchedby key demographic and health characteristics and controlling for important unmatched characteristics, to estimate the difference in risk of hospitalization likely attributable to chemotherapy. This approach, consistentwithpreviousstudiesoftreatmentcomplications [41][42][43] and with the epidemiologic concept of attributable or excess risk, 44 does not require direct attribution of each hospitalization to a specific cause, a task that is challenging even with detailed clinical information. 45 However, there may have been residual confounding by unmeasured factors, such as pretreatment symptom burden, performance status, and functional status, other risk factors for treatment-related adverse effects, patient preferences, or physician recommendations.…”

mentioning

confidence: 73%

ReCAP: Hospitalizations in Older Adults With Advanced Cancer: The Role of Chemotherapy

O'Neill

Atoria

O'Reilly

et al. 2016

JOP

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CONTEXT AND QUESTION ASKED: In patients with metastatic cancer, chemotherapy may provide symptom control, prevent complications, prolong life, or improve quality of life. Except in rare cases, however, patients with metastatic disease will not be cured. In older patients with metastatic cancer, hospitalization for treatment toxicity may reduce the quality of an already limited life expectancy. We evaluated the association between chemotherapy for metastatic cancer and risk of hospitalization. MAIN CONCLUSION:Hospitalizations are common in patients with incurable advanced malignancies and are more likely among those who receive chemotherapy. APPROACH:In the linked SEER-Medicare dataset, we identified Medicare beneficiaries aged 66 years or older with a primary diagnosis of metastatic breast, colorectal, ovarian, bladder, lung, pancreas, esophageal, stomach, or prostate cancer between 2001 and 2009 who died by the end of 2010. Chemotherapy recipients and nonrecipients were pairmatched by age, sex, race, comorbidity, geographic region and survival duration. The primary endpoint was hospital admission, identified in inpatient claims between cancer diagnosis and the first of hospice admission or death. We also identified the subset of admissions associated with a primary or secondary diagnosis code suggestive of an adverse effect of chemotherapy. The association between chemotherapy and hospitalization was estimated in separate multivariable Cox proportional-hazards regression models for each cancer site, accounting for the matched-pairs design and controlling for unmatched demographic and disease characteristics. RESULTS:Of 18,486 patients who received chemotherapy for metastatic cancer, 92% were hospitalized at least once for any reason, including 51% hospitalized for a likely toxicity. The corresponding rates among matched non-recipients were 83% and 34% ( Figure). In nearly all cancers, chemotherapy recipients had a greater risk of hospitalization for a likely toxicity or for any cause. Chemotherapy recipients had substantially higher hospitalization for infection or fever (21% v 15%), hematologic complications (11% v 3%), dehydration (13% v 6%), and PE or DVT (9% v 4%) compared with nonrecepients. Chemotherapy was associated with a significantly increased risk of likely toxicity-related hospitalization in nearly all cancers, controlling for sociodemographic characteristics and other treatment. The association was greatest in patients with metastatic esophageal cancer (adjusted hazard ratio, 2.00; 95% CI, 1.11 to 3.60) and smallest in patients with metastatic prostate cancer (adjusted hazard ratio, 1.22; 95% CI, 1.01 to 1.47). 151Original Contribution CARE DELIVERY Original Contribution CARE DELIVERY INTERPRETATION: Older patients receiving chemotherapy for incurable advanced cancers are at high risk of hospitalization, of which a non-negligible proportion is likely attributable to adverse effects of treatment. Infection, fever, dehydration, and hematologic complications constitute a large proportion of these ev...

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“…However, large observational studies have shown that the highest risk for major adverse cardiac events (MACE) following surgery after recent PCI is confined to the first 6 months after stent placement with no significant difference in the rate of postoperative MACE by stent type. 2–5 Given that stent types do not explain the inverse relationship between time from PCI and perioperative MACE risk, we explored whether the indication for stent placement may provide additional information regarding the risk of MACE after noncardiac surgery.…”

mentioning

confidence: 99%

Association of Coronary Stent Indication With Postoperative Outcomes Following Noncardiac Surgery

et al. 2016

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IMPORTANCE Current guidelines for delaying surgery after coronary stent placement are based on stent type. However, the indication for the stent may be an important risk factor for postoperative major adverse cardiac events (MACE). OBJECTIVE To determine whether the clinical indication for a coronary stent is associated with postoperative MACE. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study in patients at US Veterans Affairs hospitals who had a coronary stent placed between January 1,2000, and December 31, 2010, and underwent noncardiac surgery within the following 24 months. The association between the indication for stent and postoperative MACE rates was examined using logistic regression to control for patient and procedure factors. EXPOSURES Three subgroups of stent indication were examined: (1) myocardial infarction (MI); (2) unstable angina; and (3) revascularization not associated with acute coronary syndrome (non-ACS). MAIN OUTCOMES AND MEASURES Composite 30-day postoperative MACE rates including all-cause mortality, MI, or revascularization. RESULTS Among 26 661 patients (median [IQR] age, 68 [61.0–76.0] years; 98.4% male; 88.1% white) who underwent 41 815 surgical procedures within 24 months following coronary stent placement, the stent indication was MI in 32.8% of the procedures, unstable angina in 33.8%, and non-ACS in 33.4%. Postoperative MACE rates were significantly higher in the MI group (7.5%) compared with the unstable angina (2.7%) and non-ACS (2.6%) groups (P < .001). When surgery was performed within 3 months of percutaneous coronary intervention, adjusted odds of MACE were significantly higher in the MI group compared with the non-ACS group (odds ratio [OR] = 5.25; 95% CI, 4.08–6.75). This risk decreased over time, although it remained significantly higher at 12 to 24 months from percutaneous coronary intervention (OR = 1.95; 95% CI, 1.58–2.40). The adjusted odds of MACE for the unstable angina group were similar to those for the non-ACS group when surgery was performed within 3 months (OR = 1.11; 95% CI, 0.80–1.53) or between 12 and 24 months (OR = 1.08; 95% CI, 0.86–1.37) from stent placement. Stent type was not significantly associated with MACE regardless of indication. CONCLUSIONS AND RELEVANCE Surgery in patients with a coronary stent placed for MI was associated with increased postoperative MACE rates compared with other stent indications. The risk declined over time from PCI, and delaying surgery up to 6 months in this cohort of patients with stents may be important regardless of stent type.

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The Incremental Risk of Coronary Stents on Postoperative Adverse Events

Abstract: Surgery after coronary stent placement is associated with an approximate 2% absolute risk for postoperative MI but no difference in mortality compared with nonstented matched controls.

Cited by 50 publications

References 24 publications

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS

ReCAP: Hospitalizations in Older Adults With Advanced Cancer: The Role of Chemotherapy

Association of Coronary Stent Indication With Postoperative Outcomes Following Noncardiac Surgery

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