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Guideliner for stenting series#
1 The current guidelines recommend delaying elective noncardiac surgery by 365 days in patients with drug-eluting stents (DESs) or 42 days in patients with bare metal stents (BMSs) based on case series and expert opinion, but an increasing number of cohort studies have shown that the appropriate timing for surgery following DES placement could possibly be shortened. With a 26% reduction in MACEs following the guidelines, it would appear that the guidelines did improve postoperative outcomes however, when examined over time, it becomes evident that there are many more factors influencing management of patients with cardiac stents in need of subsequent surgery.Īpproximately 1 in 5 patients with a cardiac stent will undergo noncardiac surgery in the 2 years following placement of their stent. In contrast, MACE rates with bare metal stent placement increased from 4.3% in 2005 to 8.0% in 2007 but decreased to 4.8% following the guidelines’ publication.Ĭonclusions and Relevance After the guidelines’ publication, noncardiac surgery was delayed in patients with DESs but not bare metal stents. On further examination of trends across time, MACE rates with DES placement began to decrease prior to the guidelines’ publication from 5.5% in 2005 to 4.3% in 2006 and remained stable through 2010. After adjusting for cardiac risk factors and procedure characteristics, there was an overall absolute risk reduction of 0.9% for MACEs (odds ratio = 0.74 95% CI, 0.62-0.89). In addition, postoperative MACE rates decreased from 4.2% to 3.3% ( P = .002). After the guidelines’ publication, surgery timing increased following DES placement from 323 to 404 days ( P < .001) and decreased following bare metal stent placement from 402 to 309 days ( P < .001). A total of 11 026 operations (66.3%) followed DES placement, and 5608 (33.7%) followed bare metal stent placement.
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Results The median time to surgery was 364 days (interquartile range, 184-528 days). We used χ 2 tests to examine differences in bivariate frequencies and used logistic models to examine adjusted associations with 2-year postoperative MACEs. Main Outcomes and Measures Composite 30-day postoperative MACEs. Overall, 16 634 elective noncardiac operations were identified (8034 in the preguideline period 8600 in the postguideline period). Surgery patients admitted through the emergency department or transferred from another hospital were excluded from analyses. The preguideline period was defined as fiscal years 2005 through 2007 and the postguideline period was defined as fiscal years 2008 through 2010. The Veterans Affairs Surgical Quality Improvement Program data were used to identify subsequent operations in the 2 years following stenting. Objective To examine the effect of the guidelines on postoperative major adverse cardiac events (MACEs) in subsequent noncardiac surgery.ĭesign, Setting, and Participants Patients receiving a cardiac stent between fiscal years 20 were identified by International Classification of Diseases, Ninth Revision diagnosis codes in the Veterans Affairs Medical SAS data sets. Importance In 2007, the American College of Cardiology/American Heart Association guidelines were revised for patients with cardiac stents in need of subsequent surgery to recommend delaying elective noncardiac surgery by 365 days in patients with drug-eluting stents (DESs). Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.