Noncardiac surgery after stenting ups myocardial infarction risk in ACS, SAP patients

In patients with acute coronary syndrome (ACS) or stable angina pectoris (SAP), undergoing noncardiac surgery after stenting increases the risk of myocardial infarction (MI), but only when procedures are performed during acute admission, a recent study has found.

Researchers enrolled patients who had received drug-eluting stent implants for ACS (n=2,291) or SAP (n=1,801) and underwent noncardiac surgery within 1 year after the procedure. Outcomes included MI and all-cause mortality, which were detected through registries and compared against the general population.

Thirty-nine ACS patients developed MI after noncardiac surgery, while 38 died. Most of these cases, however, occurred in those who underwent such surgery within 30 days of stenting: 32 of the MI cases and 30 of the deaths occurred in patients who underwent surgery during acute admission.

Conditional logistic regression analysis confirmed that the risk of MI was significantly elevated when surgery was performed within 30 days (odds ratio [OR], 20.1, 95 percent confidence interval [CI], 8.85–45.6), but not when performed from day 31 to 365 (OR, 2.18, 95 percent CI, 0.89–5.38). On the other hand, no excess risk of death was reported (OR, 1.10, 95 percent CI, 0.82–1.47).

A similar pattern was reported for SAP patients, in whom the likelihood of MI was elevated after poststenting noncardiac surgery (OR, 2.88, 95 percent CI, 1.18–7.02), driven mostly by events arising when surgery was performed during acute admission (OR, 1.90, 95 percent CI, 0.70–5.14). Death risk was not aggravated after surgery (OR, 0.88, 95 percent CI, 0.60–1.28).