Surgery Too Soon After Stenting Raises Heart Risks
May 6, 2010 – Patients who can postpone noncardiac surgery for at least six weeks after receiving a coronary stent are less likely to suffer reduced blood flow to the heart, heart attack and death than those who have surgery sooner. This was the finding of Scottish researchers in Circulation: Cardiovascular Interventions, an American Heart Association journal.
Stents are used in more than 90 percent of angioplasty patients in Scotland, according to the study. In the broad retrospective study, researchers found that 42 percent of patients undergoing noncardiac surgery within six weeks of stent implantation were more likely to suffer heart complications, including decreased blood flow to the heart (ischemia), heart attack and death. In comparison, these complications occurred in 13 percent of patients whose surgeries were performed beyond six weeks post-implantation.
The risk of heart problems following noncardiac surgery was even greater among patients whose stents were inserted as treatment for a recent heart attack (occurring in 65 percent of patients) than among those with stable but chronic disease (occurring in 32 percent of patients). The type of stent — bare metal vs. drug-eluting — didn't affect risk, which was similar for the first two years after stent implantation.
The researchers examined records for 1,953 patients, with an average age of 64, who received coronary stents in Scotland between April 2003 and March 2007. They used hospital admission data and information from the Scottish Coronary Revascularization Register.
Previous studies have found that patients who underwent noncardiac surgery within four to six weeks of bare-metal stent implantation had a greater incidence of serious heart complications. However, those studies did not clarify how long the risk persisted after stent implantation and whether it was the same in patients with drug-eluting stents.
"These findings have important implications for a large number of patients," said Nicholas L.M. Cruden, Ph.D., M.B., first author of the study and cardiology lecturer at the University of Edinburgh in Scotland. "In the current study, 4.4 percent of patients undergoing percutaneous coronary intervention underwent noncardiac surgery within one year of coronary stent implantation."
A Health Services Research Grant from the Scottish government's Chief Scientist Office funded this study.
Stent Stats from the American Heart Association
• More than 70 percent of coronary angioplasty procedures in the United States also include stenting.
• In 2006, about 65 percent of percutaneous coronary intervention (PCI) procedures were performed on men, and approximately 50 percent were performed on people age 65 or older.
• In 2006, an estimated 1,313,000 PCI procedures were performed in the United States.
• In 2006, approximately 76 percent of stents implanted during PCI were drug-eluting, compared with 24 percent bare-metal stents.
• In 2006, there were 652,000 PCI procedures with stents – 425,000 in men, 227,000 in women.
For more information: www.americanheart.mediaroom.com