ARTICLE
Catastrophic outcomes of noncardiac surgery soon after coronary stenting
Grzegorz L. Ka uza, MD, PhDa,
Jane Josepha,
Joseph R. Lee, MDa,
Michael E. Raizner, MDa and
Albert E. Raizner, MD, FACCa
a Methodist Hospital, Baylor College of Medicine, Houston, Texas, USA
Manuscript received May 11, 1999;
revised manuscript received September 20, 1999,
accepted December 15, 1999.
Reprint requests and correspondence: Dr. Albert E. Raizner, The Methodist Hospital, 6535 Fannin, MS F1034, Houston, Texas 77030
araizner{at}msn.com
OBJECTIVES
To assess the clinical course of patients who have undergone coronary stent placement less than six weeks before noncardiac surgery.
BACKGROUND
Surgical and percutaneous transluminal coronary angioplasty revascularization performed before high-risk noncardiac surgery is expected to reduce perioperative cardiac morbidity and mortality. Perioperative and postoperative complications in patients who have undergone coronary stenting before a noncardiac surgery have not been studied.
METHODS
Forty patients who underwent coronary stent placement less than six weeks before noncardiac surgery requiring a general anesthesia were included in the study (1–39 days, average: 13 days). The records were screened for the occurrence of adverse clinical events, including myocardial infarction, stent thrombosis, peri- and postoperative bleeding and death.
RESULTS
In 40 consecutive patients meeting the study criteria, there were seven myocardial infarctions (MIs), 11 major bleeding episodes and eight deaths. All deaths and MIs, as well as 8/11 bleeding episodes, occurred in patients subjected to surgery fewer than 14 days from stenting. Four patients expired after undergoing surgery one day after stenting. Based on electrocardiogram, enzymatic and angiographic evidence, stent thrombosis accounted for most of the fatal events. The time between stenting and surgery appeared to be the main determinant of outcome.
CONCLUSIONS
Postponing elective noncardiac surgery for two to four weeks after coronary stenting should permit completion of the mandatory antiplatelet regimen, thereby reducing the risk of stent thrombosis and bleeding complications.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass grafting | | CAD | = coronary artery disease | | CX | = circumflex coronary artery | | ECG | = electrocardiogram | | LAD | = left anterior descending coronary artery | | MI | = myocardial infarction | | OM | = obtuse marginal branch | | PTCA | = percutaneous transluminal coronary angioplasty | | RCA | = right coronary artery |
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Br. J. Anaesth.,
June 1, 2006;
96(6):
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[Abstract]
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A. Auerbach and L. Goldman
Assessing and Reducing the Cardiac Risk of Noncardiac Surgery
Circulation,
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G Karthikeyan and B Bhargava
Managing patients undergoing non-cardiac surgery: need to shift emphasis from risk stratification to risk modification
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[Abstract]
[Full Text]
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J. T. Murphy and B. G. Fahy
Thrombosis of Sirolimus-Eluting Coronary Stent in the Postanesthesia Care Unit
Anesth. Analg.,
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[Abstract]
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P.J. Devereaux, L. Goldman, S. Yusuf, K. Gilbert, K. Leslie, and G. H. Guyatt
Surveillance and prevention of major perioperative ischemic cardiac events in patients undergoing noncardiac surgery: a review
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[Abstract]
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H.-J. Priebe
Perioperative myocardial infarction--aetiology and prevention
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[Abstract]
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E. Ferrari, M. Benhamou, P. Cerboni, and B. Marcel
Coronary syndromes following aspirin withdrawal: A special risk for late stent thrombosis
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[Abstract]
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E. O. McFalls, H. B. Ward, T. E. Moritz, S. Goldman, W. C. Krupski, F. Littooy, G. Pierpont, S. Santilli, J. Rapp, B. Hattler, et al.
Coronary-Artery Revascularization before Elective Major Vascular Surgery
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[Abstract]
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J. N. Ghansah and J. T. Murphy
Complications of Major Aortic and Lower Extremity Vascular Surgery
Seminars in Cardiothoracic and Vascular Anesthesia,
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335 - 361.
[Abstract]
[PDF]
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F Alfonso, A Suarez, D J Angiolillo, M Sabate, J Escaned, R Moreno, R Hernandez, C Banuelos, and C Macaya
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Heart,
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[Abstract]
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J.P. Collet, G. Montalescot, B. Blanchet, M.L. Tanguy, J.L. Golmard, R. Choussat, F. Beygui, L. Payot, N. Vignolles, J.P. Metzger, et al.
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Circulation,
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[Abstract]
[Full Text]
[PDF]
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U. K. H. Wiegand, D. LeJeune, F. Boguschewski, H. Bonnemeier, F. Eberhardt, H. Schunkert, and F. Bode
Pocket Hematoma After Pacemaker or Implantable Cardioverter Defibrillator Surgery: Influence of Patient Morbidity, Operation Strategy, and Perioperative Antiplatelet/Anticoagulation Therapy
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[Abstract]
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A. F. Hernandez, L. K. Newby, and C. M. O'Connor
Preoperative Evaluation for Major Noncardiac Surgery: Focusing on Heart Failure
Arch Intern Med,
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[Abstract]
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D. E. Newby and A. F. Nimmo
Editorial II: Prevention of cardiac complications of non-cardiac surgery: stenosis and thrombosis
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C. Marcucci, P.-G. Chassot, J.-P. Gardaz, L. Magnusson, H.-B. Ris, A. Delabays, and D. R. Spahn
Fatal myocardial infarction after lung resection in a patient with prophylactic preoperative coronary stenting{dagger}
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[Abstract]
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G. W. Smetana, S. L. Cohn, and V. A. Lawrence
Update in Perioperative Medicine
Ann Intern Med,
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C. E. Mendoza, N. Shah, and S. Virani
Percutaneous coronary intervention before noncardiac surgery: more threat than benefit?
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J. Auer, R. Berent, T. Weber, and B. Eber
Risk of noncardiac surgery in the months following placement of a drug-eluting coronary stent
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R. Mehran, E. D. Aymong, D. T. Ashby, T. Fischell, H. Whitworth Jr, R. Siegel, W. Thomas, S. C. Wong, R. Narasimaiah, A. J. Lansky, et al.
Safety of an Aspirin-Alone Regimen After Intracoronary Stenting With a Heparin-Coated Stent: Final Results of the HOPE (HEPACOAT and an Antithrombotic Regimen of Aspirin Alone) Study
Circulation,
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[Abstract]
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S. H. Wilson, P. Fasseas, J. L. Orford, R. J. Lennon, T. Horlocker, N. E. Charnoff, S. Melby, and P. B. Berger
Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting
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[Abstract]
[Full Text]
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D. Mukherjee and K. A. Eagle
Perioperative Cardiac Assessment for Noncardiac Surgery: Eight Steps to the Best Possible Outcome
Circulation,
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[Full Text]
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L. Glantz, T. Ezri, Y. Cohen, S. Konichezky, A. Caspi, D. Geva, and A. Leviav
Perioperative Myocardial Ischemia in Patients Undergoing Sternectomy Shortly After Coronary Artery Bypass Grafting
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[Abstract]
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P. A. Grayburn and L D. Hillis
Cardiac Events in Patients Undergoing Noncardiac Surgery: Shifting the Paradigm from Noninvasive Risk Stratification to Therapy
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[Abstract]
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M. Licker, G. Khatchatourian, A. Schweizer, M. Bednarkiewicz, D. Tassaux, and C. Chevalley
The Impact of a Cardioprotective Protocol on the Incidence of Cardiac Complications After Aortic Abdominal Surgery
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[Abstract]
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P.-G. Chassot, A. Delabays, and D. R. Spahn
Preoperative evaluation of patients with, or at risk of, coronary artery disease undergoing non-cardiac surgery
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[Abstract]
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R. Chun, B. A. Orser, and M. Madan
Platelet Glycoprotein IIb/IIIa Inhibitors: Overview and Implications for the Anesthesiologist
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L. A. Fleisher and K. A. Eagle
Guidelines on Perioperative Cardiovascular Evaluation: What Have We Learned Over the Past 6 Years to Warrant an Update?
Anesth. Analg.,
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