Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Cardiology, Thorax Center, Erasmus Medical Center, Rotterdam, The Netherlands.
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
J Am Coll Cardiol. 2016 Mar 8;67(9):1038-1049. doi: 10.1016/j.jacc.2015.11.063.
Previous studies have observed high rates of perioperative cardiovascular events in patients with coronary stents undergoing noncardiac surgery (NCS). It is uncertain whether this finding reflects an independent association.
The goal of this study was to assess the independent relationship between prior coronary stent implantation and the occurrence of perioperative major adverse cardiac and cerebrovascular events (MACCE) and bleeding and its relation with time from stenting to NCS.
A total of 24,313 NCS cases at the Mayo Clinic (Rochester, Minnesota) from 2006 through 2011 were included in the study; 1,120 (4.6%) cases involved patients with coronary stents. MACCE was defined as death, myocardial infarction, cardiac arrest, or stroke. Age-adjusted odds ratios (aORs) were calculated after propensity adjustment for Revised Cardiac Risk Index factors and other conventional risk factors.
The 30-day MACCE rates were 3.7% and 1.5% in stented and unstented patients, respectively (p < 0.001). The risk of MACCE was largely related to the time from stent implantation to NCS, indicating substantially elevated risk in the first year after stenting (aOR: 2.59; 95% confidence interval [CI]: 1.36 to 4.94) but not thereafter (aOR: 0.89; 95% CI: 0.59 to 1.36). Bleeding displayed a similar pattern, indicating elevated risk in the first year after stenting (aOR: 2.23; 95% CI: 1.55 to 3.21) but not thereafter (aOR: 1.07; 95% CI: 0.89 to 1.28). Subgroup analysis in patients with known stent type found that the increased risk of both MACCE and bleeding >1 month after stent implantation was not limited to only those with drug-eluting stents.
This study found that prior coronary stent implantation is an independent risk factor for MACCE and bleeding when time from stenting to NCS is <1 year, both in patients with bare-metal and drug-eluting stents.
先前的研究观察到，在接受非心脏手术（NCS）的冠状动脉支架植入患者中，围手术期心血管事件发生率较高。目前尚不确定这一发现是否反映了独立的相关性。
本研究旨在评估既往冠状动脉支架植入与围手术期主要不良心脏和脑血管事件（MACCE）及出血的发生以及与支架置入至 NCS 时间的关系。
本研究纳入了 2006 年至 2011 年梅奥诊所（明尼苏达州罗切斯特）的 24313 例 NCS 病例，其中 1120 例（4.6%）患者有冠状动脉支架。MACCE 定义为死亡、心肌梗死、心脏骤停或中风。采用修正后的心脏风险指数因素和其他常规危险因素进行倾向调整后，计算年龄调整后的比值比（aOR）。
支架组和非支架组的 30 天 MACCE 发生率分别为 3.7%和 1.5%（p < 0.001）。MACCE 的风险主要与支架植入至 NCS 的时间有关，表明支架植入后第一年风险显著升高（aOR：2.59；95%置信区间[CI]：1.36 至 4.94），但此后风险不再升高（aOR：0.89；95% CI：0.59 至 1.36）。出血也呈现出类似的模式，表明支架植入后第一年风险升高（aOR：2.23；95% CI：1.55 至 3.21），但此后风险不再升高（aOR：1.07；95% CI：0.89 至 1.28）。在已知支架类型的患者亚组分析中，支架植入>1 个月后发生 MACCE 和出血的风险增加不仅限于药物洗脱支架。
本研究发现，支架置入至 NCS 时间<1 年时，既往冠状动脉支架植入是 MACCE 和出血的独立危险因素，无论是在金属裸支架还是药物洗脱支架患者中均如此。
