Home > Interventional Cardiology > 30 Day Myocardial Infarction and Cardiac Death post surgery after previous PCI

30 Day Myocardial Infarction and Cardiac Death post surgery after previous PCI

Egholm et al report on the 30 day event rates of myocardial infarction/cardiac death/all cause mortality in patients with prior PCI (<1 month, 1-2 month.2-12 month intervals PCI to surgery). Data was from National Registry. The control group was patients without ischemic heart disease. An hazard for myocardial infarction and cardiac death for those with PCI within 1 month of surgery was demonstrated.

ABSTRACT

BACKGROUND

Guidelines recommend postponing surgery for at least 6 months after treatment with a drug-eluting stent by percutaneous coronary intervention (DES-PCI).

OBJECTIVES

The goal of this study was to evaluate the surgical risk associated with DES-PCI compared with that in nonstented patients without ischemic heart disease (IHD).

METHODS

Between 2005 and 2012, a total of 22,590 patients underwent DES-PCI in western Denmark. By
record-linking the Western Denmark Heart Registry and the Danish National Patient Register, we evaluated 4,303 DES-PCI–treated patients with a surgical procedure and compared them with a control group of patients without previous IHD undergoing similar surgical procedures (n ¼ 20,232). Events of interest were myocardial infarction (MI), cardiac death, and all-cause mortality within 30 days after surgery.

RESULTS

Surgery in DES-PCI–treated patients was associated with an increased risk of MI (1.6% vs. 0.2%; odds ratio[OR]: 4.82; 95% confidence interval [CI]: 3.25 to 7.16) and cardiac death (1.0% vs. 0.2%; OR: 5.87; 95% CI: 3.60 to 9.58) but not all-cause mortality (3.1% vs. 2.7%; OR: 1.12; 95% CI: 0.91 to 1.38). When stratified for time from PCI to surgery, only surgery within the first month was associated with a significant increased risk of events.

CONCLUSIONS

Patients requiring surgery within 12 months after DES-PCI had an increased risk of MI and cardiac death compared with patients without IHD. The increased risk was only present within the first month after DES-PCI, suggesting that surgery might be undertaken earlier than currently recommended.

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