• Karim D Mahmoud, Saurabh Sanon, Elizabeth B Habermann, Ryan J Lennon, Kristine M Thomsen, Douglas L Wood, Felix Zijlstra, Robert L Frye, and David R Holmes.
• Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands.
• J. Am. Coll. Cardiol. 2016 Mar 8; 67 (9): 1038-1049.

BackgroundPrevious studies have observed high rates of perioperative cardiovascular events in patients with coronary stents undergoing noncardiac surgery (NCS). It is uncertain whether this finding reflects an independent association.ObjectivesThe goal of this study was to assess the independent relationship between prior coronary stent implantation and the occurrence of perioperative major adverse cardiac and cerebrovascular events (MACCE) and bleeding and its relation with time from stenting to NCS.MethodsA total of 24,313 NCS cases at the Mayo Clinic (Rochester, Minnesota) from 2006 through 2011 were included in the study; 1,120 (4.6%) cases involved patients with coronary stents. MACCE was defined as death, myocardial infarction, cardiac arrest, or stroke. Age-adjusted odds ratios (aORs) were calculated after propensity adjustment for Revised Cardiac Risk Index factors and other conventional risk factors.ResultsThe 30-day MACCE rates were 3.7% and 1.5% in stented and unstented patients, respectively (p < 0.001). The risk of MACCE was largely related to the time from stent implantation to NCS, indicating substantially elevated risk in the first year after stenting (aOR: 2.59; 95% confidence interval [CI]: 1.36 to 4.94) but not thereafter (aOR: 0.89; 95% CI: 0.59 to 1.36). Bleeding displayed a similar pattern, indicating elevated risk in the first year after stenting (aOR: 2.23; 95% CI: 1.55 to 3.21) but not thereafter (aOR: 1.07; 95% CI: 0.89 to 1.28). Subgroup analysis in patients with known stent type found that the increased risk of both MACCE and bleeding >1 month after stent implantation was not limited to only those with drug-eluting stents.ConclusionsThis study found that prior coronary stent implantation is an independent risk factor for MACCE and bleeding when time from stenting to NCS is <1 year, both in patients with bare-metal and drug-eluting stents.Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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