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Risks of noncardiac surgery early after percutaneous coronary intervention - 15/11/19

Doi : 10.1016/j.ahj.2019.07.010 
Nathaniel R. Smilowitz, MD a, b, , Jeffrey Lorin, MD a, b, Jeffrey S. Berger, MD, MS a, c
a Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 
b Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY 
c Department of Surgery, New York University School of Medicine, New York, NY 

Reprint requests: Nathaniel Smilowitz, MD, Assistant Professor of Medicine, The Leon H. Charney Division of Cardiology, NYU Langone Health, NYU School of Medicine, 423 E 23rd St, Room 12020-W, New York, NY 10010.The Leon H. Charney Division of CardiologyNYU Langone Health, NYU School of Medicine423 E 23rd St, Room 12020-WNew YorkNY10010

Abstract

Background

Prior registry data suggest that 4%-20% of patients require noncardiac surgery (NCS) within 2 years of percutaneous coronary intervention (PCI). Contemporary data on NCS after PCI in the United States among women and men are limited. We determined the rate of early hospital readmission for NCS and associated outcomes in a large cohort of patients who underwent PCI in the United States.

Methods

Adults undergoing PCI between January 1 and June 30, 2014, were identified from the Nationwide Readmission Database. Patients readmitted for NCS within 6 months of PCI were identified. Outcomes of interest were in-hospital death, myocardial infarction (MI), and bleeding defined by International Classification of Diseases, Ninth Revision, codes.

Results

Among 221,379 patients who underwent PCI and survived to hospital discharge, 3.5% (n = 7,696) were readmitted for NCS within 6 months post-PCI, and 41% of these hospitalizations were elective. Early NCS was complicated by MI in 4.7% of cases, and 21% of perioperative MIs were fatal. Bleeding was recorded in 32.0% of patients. All-cause mortality occurred in 4.4% of patients (n = 339) readmitted for surgery. The risk of death or MI was greatest when NCS was performed within the first month after PCI.

Conclusions

Despite clear guidelines to avoid surgery early after PCI, NCS was performed in 1 of every 29 patients with recent PCI, corresponding to as many as ~30,000 patients each year nationwide. Surgical mortality and perioperative MI were high in this setting. Strategies to minimize perioperative thrombotic and bleeding risks during readmission for NCS after PCI are necessary.

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Highlights

3.5% of patients were readmitted for noncardiac surgery within 6 months of PCI.
Death or myocardial infarction (MI) occurred in 8.1% of those readmitted for surgery
Surgery within 1 month after PCI was associated with the highest risk.
41% of surgical hospitalizations within 6 months after PCI were elective
Perioperative death or MI occurred in 5% of elective hospitalizations for surgery

Il testo completo di questo articolo è disponibile in PDF.

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 Conflict of interest disclosures: none.
 Sponsor/funding: This research is supported in part by an NYU CTSA grant, UL1 TR001445 and KL2 TR001446, from the National Center for Advancing Translational Sciences, National Institutes of Health.


© 2019  Pubblicato da Elsevier Masson SAS.
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Vol 217

P. 64-71 - Novembre 2019 Ritorno al numero
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