Risks of noncardiac surgery early after percutaneous coronary intervention

Autor: Nathaniel R. Smilowitz, Jeffrey S. Berger, Jeffrey D. Lorin
Rok vydání: 2019
Předmět:
Male
Risk
medicine.medical_specialty
Time Factors
Databases
Factual
medicine.medical_treatment
Myocardial Infarction
Postoperative Hemorrhage
030204 cardiovascular system & hematology
Patient Readmission
behavioral disciplines and activities
Article
03 medical and health sciences
Percutaneous Coronary Intervention
Sex Factors
0302 clinical medicine
mental disorders
Odds Ratio
medicine
Hospital discharge
Humans
Hospital Mortality
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Aged
Hospital readmission
business.industry
Percutaneous coronary intervention
Drug-Eluting Stents
Odds ratio
Perioperative
Middle Aged
medicine.disease
United States
surgical procedures
operative
Elective Surgical Procedures
Surgical Procedures
Operative
Emergency medicine
Conventional PCI
Female
Cardiology and Cardiovascular Medicine
business
Noncardiac surgery
Zdroj: Am Heart J
ISSN: 0002-8703
DOI: 10.1016/j.ahj.2019.07.010
Popis: 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.
Databáze: OpenAIRE
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