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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
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Improved adverse postoperative outcomes with revised American College of Cardiology/American Heart Association
Laura A Graham1, Brandon A Singletary1, Joshua S Richman1
1Center for Surgical, Medical Acute Care Research, and Transitions, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama2Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham.
JAMA Surgery
|September 5, 2014
Summary
The 2007 guidelines delayed noncardiac surgery after drug-eluting stents (DESs), reducing major adverse cardiac events (MACEs). However, trends suggest other factors also influenced outcomes for patients with cardiac stents.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Health Policy
Background:
- The 2007 American College of Cardiology/American Heart Association guidelines recommended delaying elective noncardiac surgery for 365 days in patients with drug-eluting stents (DESs).
- Prior to 2007, management strategies for patients with cardiac stents undergoing subsequent surgery varied.
- Understanding the impact of these guidelines on postoperative outcomes is crucial for patient care.
Purpose of the Study:
- To evaluate the effect of the 2007 guidelines on postoperative major adverse cardiac events (MACEs) in patients undergoing subsequent noncardiac surgery.
- To analyze trends in surgical timing and MACE rates following DES and bare metal stent (BMS) placement before and after guideline implementation.
Main Methods:
- Retrospective analysis of Veterans Affairs data from fiscal years 2005-2010.
- Identification of patients receiving cardiac stents and undergoing subsequent elective noncardiac surgery.
- Comparison of MACE rates and surgical timing in the preguideline (2005-2007) and postguideline (2008-2010) periods.
Main Results:
- Following guideline publication, the median time to surgery increased for DES patients (323 to 404 days) and decreased for BMS patients (402 to 309 days).
- Overall 30-day postoperative MACE rates decreased from 4.2% to 3.3% (P=.002), representing a 26% reduction.
- MACE rates for DES placement showed a decreasing trend prior to guideline implementation, while BMS rates increased before and decreased after the guidelines.
Conclusions:
- The 2007 guidelines appear to have improved postoperative outcomes by delaying noncardiac surgery in patients with DESs.
- Analysis over time indicates that factors beyond the guidelines influence the management and outcomes of patients with cardiac stents.
- Further research is needed to fully elucidate the multifactorial influences on patient management and outcomes.
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