Risk of Major Adverse Cardiac Events Following Noncardiac Surgery in Patients With Coronary Stents

IMPORTANCE Guidelines recommend delaying noncardiac surgery in patients after coronary stent procedures for 1 year after drug-eluting stents (DES) and for 6 weeks after bare metal stents (BMS). The evidence underlying these recommendations is limited and conflicting. OBJECTIVE To determine risk factors for adverse cardiac events in patients undergoing noncardiac surgery following coronary stent implantation. DESIGN, SETTING, AND PARTICIPANTS A national, retrospective cohort study of 41 989 Veterans Affairs (VA) and non-VA operations occurring in the 24 months after a coronary stent implantation between 2000 and 2010. Nonlinear generalized additive models examined the association between timing of surgery and stent type with major adverse cardiac events (MACE) adjusting for patient, surgery, and cardiac risk factors. A nested case-control study assessed the association between perioperative antiplatelet cessation and MACE. MAIN OUTCOMES AND MEASURES A composite 30-day MACE rate of all-cause mortality, myocardial infarction, and cardiac revascularization. RESULTS Within 24 months of 124 844 coronary stent implantations (47.6% DES, 52.4% BMS), 28 029 patients (22.5%; 95% CI, 22.2%-22.7%) underwent noncardiac operations resulting in 1980 MACE (4.7%; 95% CI, 4.5%-4.9%). Time between stent and surgery was associated with MACE (