Coronary artery stenting and non-cardiac surgery—a prospective outcome study
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...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2006-06, Vol.96 (6), p.686-693 |
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| container_title | British journal of anaesthesia : BJA |
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| creator | Vicenzi, M.N. Meislitzer, T. Heitzinger, B. Halaj, M. Fleisher, L.A. Metzler, H. |
| description | 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.
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.
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 ( |
| doi_str_mv | 10.1093/bja/ael083 |
| format | Article |
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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.
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.
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.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1093/bja/ael083</identifier><identifier>PMID: 16670113</identifier><identifier>CODEN: BJANAD</identifier><language>eng</language><publisher>Oxford: Elsevier Ltd</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Anesthesia ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Blood Loss, Surgical ; complications ; complications, stent thrombosis ; Coronary Stenosis - therapy ; Coronary Thrombosis - prevention & control ; Female ; Heparin - therapeutic use ; Humans ; Male ; Medical sciences ; Middle Aged ; percutaneous coronary intervention (PCI) ; perioperative ; Perioperative Care - methods ; Platelet Aggregation Inhibitors - adverse effects ; Platelet Aggregation Inhibitors - therapeutic use ; Postoperative Complications ; procedure ; procedure, percutaneous coronary intervention (PCI) ; Prospective Studies ; risk ; risk, perioperative ; stent thrombosis ; Stents - adverse effects ; Surgical Procedures, Operative ; Time Factors ; Treatment Outcome</subject><ispartof>British journal of anaesthesia : BJA, 2006-06, Vol.96 (6), p.686-693</ispartof><rights>2006 British Journal of Anaesthesia</rights><rights>The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org 2006</rights><rights>2006 INIST-CNRS</rights><rights>Copyright Oxford University Press(England) Jun 2006</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c588t-9b9bda07c1292b8cb38129d3e53b1863d810afe7052a9c1d76d28bb31cc34d7b3</citedby><cites>FETCH-LOGICAL-c588t-9b9bda07c1292b8cb38129d3e53b1863d810afe7052a9c1d76d28bb31cc34d7b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,27929,27930</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17859150$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16670113$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vicenzi, M.N.</creatorcontrib><creatorcontrib>Meislitzer, T.</creatorcontrib><creatorcontrib>Heitzinger, B.</creatorcontrib><creatorcontrib>Halaj, M.</creatorcontrib><creatorcontrib>Fleisher, L.A.</creatorcontrib><creatorcontrib>Metzler, H.</creatorcontrib><title>Coronary artery stenting and non-cardiac surgery—a prospective outcome study</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>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.
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.
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.
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.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Blood Loss, Surgical</subject><subject>complications</subject><subject>complications, stent thrombosis</subject><subject>Coronary Stenosis - therapy</subject><subject>Coronary Thrombosis - prevention & control</subject><subject>Female</subject><subject>Heparin - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>percutaneous coronary intervention (PCI)</subject><subject>perioperative</subject><subject>Perioperative Care - methods</subject><subject>Platelet Aggregation Inhibitors - adverse effects</subject><subject>Platelet Aggregation Inhibitors - therapeutic use</subject><subject>Postoperative Complications</subject><subject>procedure</subject><subject>procedure, percutaneous coronary intervention (PCI)</subject><subject>Prospective Studies</subject><subject>risk</subject><subject>risk, perioperative</subject><subject>stent thrombosis</subject><subject>Stents - adverse effects</subject><subject>Surgical Procedures, Operative</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2006</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0cuKFDEUBuAgitOObnwAKQRdCOXkJF25LLXR6cFGwQsMbkJuPaStTtqkanB2PsQ8oU8yGaqxQURXyeLLOTnnR-gx4JeAJT0xG32ifY8FvYNmMOfQMs7hLpphjHmLJZAj9KCUDcbAiezuoyNgjGMAOkPvFymnqPNVo_Pg61EGH4cQLxodXRNTbK3OLmjblDFfVPDr57VudjmVnbdDuPRNGgebtr4-HN3VQ3RvrfviH-3PY_Tl7ZvPi2W7-nB6tni1am0nxNBKI43TmFsgkhhhDRX15qjvqAHBqBOA9dpz3BEtLTjOHBHGULCWzh039Bg9n-rWn3wffRnUNhTr-15Hn8aiGJeMUMb_CwkWHHhHKnz6B9ykMcc6hALJazmMWUUvJmTrAkr2a7XLYVu3pwCr2yxUzUJNWVT8ZF9xNFvvDnS__Aqe7YEuVvfrrKMN5eC46CR0-ODSuPt3w3ZyoYb447fU-VvdB-WdWp5_Va9X56uPn5bv1O0088n7mtRl8FkVG3y03oVcw1Uuhb-1uQE-r8FJ</recordid><startdate>20060601</startdate><enddate>20060601</enddate><creator>Vicenzi, M.N.</creator><creator>Meislitzer, T.</creator><creator>Heitzinger, B.</creator><creator>Halaj, M.</creator><creator>Fleisher, L.A.</creator><creator>Metzler, H.</creator><general>Elsevier Ltd</general><general>Oxford University Press</general><general>Oxford Publishing Limited (England)</general><scope>6I.</scope><scope>AAFTH</scope><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20060601</creationdate><title>Coronary artery stenting and non-cardiac surgery—a prospective outcome study</title><author>Vicenzi, M.N. ; Meislitzer, T. ; Heitzinger, B. ; Halaj, M. ; Fleisher, L.A. ; Metzler, H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c588t-9b9bda07c1292b8cb38129d3e53b1863d810afe7052a9c1d76d28bb31cc34d7b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2006</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia</topic><topic>Anesthesia. 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Cell therapy and gene therapy</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Blood Loss, Surgical</topic><topic>complications</topic><topic>complications, stent thrombosis</topic><topic>Coronary Stenosis - therapy</topic><topic>Coronary Thrombosis - prevention & control</topic><topic>Female</topic><topic>Heparin - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>percutaneous coronary intervention (PCI)</topic><topic>perioperative</topic><topic>Perioperative Care - methods</topic><topic>Platelet Aggregation Inhibitors - adverse effects</topic><topic>Platelet Aggregation Inhibitors - therapeutic use</topic><topic>Postoperative Complications</topic><topic>procedure</topic><topic>procedure, percutaneous coronary intervention (PCI)</topic><topic>Prospective Studies</topic><topic>risk</topic><topic>risk, perioperative</topic><topic>stent thrombosis</topic><topic>Stents - adverse effects</topic><topic>Surgical Procedures, Operative</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vicenzi, M.N.</creatorcontrib><creatorcontrib>Meislitzer, T.</creatorcontrib><creatorcontrib>Heitzinger, B.</creatorcontrib><creatorcontrib>Halaj, M.</creatorcontrib><creatorcontrib>Fleisher, L.A.</creatorcontrib><creatorcontrib>Metzler, H.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vicenzi, M.N.</au><au>Meislitzer, T.</au><au>Heitzinger, B.</au><au>Halaj, M.</au><au>Fleisher, L.A.</au><au>Metzler, H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Coronary artery stenting and non-cardiac surgery—a prospective outcome study</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2006-06-01</date><risdate>2006</risdate><volume>96</volume><issue>6</issue><spage>686</spage><epage>693</epage><pages>686-693</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><coden>BJANAD</coden><abstract>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.
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.
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.
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.</abstract><cop>Oxford</cop><pub>Elsevier Ltd</pub><pmid>16670113</pmid><doi>10.1093/bja/ael083</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Anesthesia Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Angioplasty, Balloon, Coronary Biological and medical sciences Blood Loss, Surgical complications complications, stent thrombosis Coronary Stenosis - therapy Coronary Thrombosis - prevention & control Female Heparin - therapeutic use Humans Male Medical sciences Middle Aged percutaneous coronary intervention (PCI) perioperative Perioperative Care - methods Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Postoperative Complications procedure procedure, percutaneous coronary intervention (PCI) Prospective Studies risk risk, perioperative stent thrombosis Stents - adverse effects Surgical Procedures, Operative Time Factors Treatment Outcome |
| title | Coronary artery stenting and non-cardiac surgery—a prospective outcome study |
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