Comparison of Early and Late Surgeries after Coronary Stent Implantation in Patients with Normal Preoperative
Sang Hyun Lee1, Eun Kyung Lee1, Hyun Joo Ahn1
1Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea.
Insights
Delaying noncardiac surgery after drug-eluting stent implantation is not necessary for patients with normal preoperative cardiac troponin levels. Early surgery within six months did not increase myocardial injury or other adverse events, challenging current guidelines.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Clinical Medicine
Background:
- Current guidelines advise delaying noncardiac surgery for 6 months post-drug-eluting stent (DES) implantation.
- This recommendation is based on limited evidence and varied event definitions.
- The impact of early surgery on myocardial injury in patients with normal preoperative high-sensitivity cardiac troponin I (hs-cTnI) remains uninvestigated.
Purpose of the Study:
- To investigate whether early noncardiac surgery within 6 months of coronary stent implantation increases myocardial injury in patients with normal preoperative hs-cTnI.
- To compare the incidence of myocardial injury and other adverse postoperative outcomes between early and late surgery groups.
Main Methods:
- Retrospective study of 186 patients undergoing noncardiac surgery (vascular, abdominal, thoracic) between 2010-2017 after coronary stent implantation with normal preoperative hs-cTnI.
- Patients were divided into early (<6 months post-PCI) and late (>6 months post-PCI) groups.
- Inverse Probability Treatment Weighting (IPTW) was used to adjust for baseline differences.
Main Results:
- Myocardial injury incidence was similar in both groups: 28.6% (early) vs. 27.8% (late) (OR 1.067, 95% CI 0.404-2.482, p=0.886).
- No significant differences were observed in secondary outcomes, including myocardial infarction, stent thrombosis, bleeding, stroke, renal failure, heart failure, or death within 30 days.
- IPTW analysis confirmed no significant differences in primary or secondary outcomes between the groups.
Conclusions:
- Early noncardiac surgery within 6 months after coronary stent implantation does not elevate the risk of myocardial injury in patients with normal preoperative hs-cTnI.
- These findings suggest that current guidelines regarding delayed surgery post-stent may be overly cautious for selected patients.
- Further research could refine perioperative management strategies for patients with coronary stents undergoing noncardiac surgery.
Abstract:
Current guidelines recommend delaying noncardiac surgery for 6 months after drug eluting stent implantation. However, this recommendation is largely based on limited evidence and various event definitions. Whether early surgery within 6 months of coronary stent implantation increases myocardial injury in patients with normal preoperative high-sensitivity cardiac troponin I (hs-cTnI) has not yet been investigated. This retrospective study assessed patients who received coronary stent implantation and underwent noncardiac surgery (vascular, abdominal, or thoracic) between 2010 and 2017 with normal preoperative hs-cTnI (n = 186). Patients were divided into early (within 6 months of PCI) and late (after 6 months of PCI) groups. The primary endpoint was the incidence of myocardial injury as diagnosed by hs-cTnI within 3 days post-operation. The secondary outcomes were myocardial infarction, stent thrombosis, emergent coronary revascularization, major bleeding (bleeding requiring transfusion or intracranial bleeding), stroke, renal failure, heart failure, or death within 30 days post-operation. Inverse probability treatment weighting (IPTW) was carried out to adjust for the intergroup baseline differences. Myocardial injury occurred in 28.6% (8/28) and 27.8% (44/158) of the early and late groups, respectively, with no difference between groups (odds ratio [OR] 1.067, 95% confidence interval [CI] 0.404, 2.482; p = 0.886). Secondary outcomes did not differ between the groups. IPTW analysis also showed no differences in myocardial injury and secondary outcomes between the groups. In conclusion, early surgery within 6 months after coronary stent implantation did not increase the incidence of myocardial injury in patients with normal preoperative hs-cTnI.
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