The incremental risk of coronary stents on postoperative adverse events. A matched cohort study

Carla N. Holcomb, Laura A. Graham, Joshua S. Richman, Kamal M.F. Itani, Thomas M. Maddox, Mary T. Hawn

Research output: Contribution to journalReview article

15 Citations (Scopus)

Abstract

Objective: To determine the incremental risk of coronary stents on adverse events in surgical patients and whether it varies over time from stent placement. Background: Postoperative adverse cardiac events decrease as the time from stent placement increases, but the risk attributable to the stent versus the underlying cardiac disease is uncertain, as prior studies lack a control surgical population. Methods: Data for patients with coronary stents implanted in a VA hospital from 2000 to 2010 were matched with VA Surgical Quality Improvement Program data to identify noncardiac surgery within 24 months of stent placement. Each patient with stent was matched with 2 surgical patients without stent on surgical characteristics and cardiac risk factors. Outcomes of myocardial infarction (MI), revascularization, and death within 30 days after surgery were modeled using logistic regression. Adjusted risk differences between stented and nonstented populations were compared across time after stent placement. Results: Adverse cardiac events followed surgery in 531 (5.7%) of the 9391 patients with stent and 680 (3.6%) of the 18,782 patients without stent (P < 0.001). In adjusted models, 30-day postoperative MI (odds ratio = 1.90; 95% confidence interval, 1.57-2.30) and revascularization (odds ratio = 2.03; 95% confidence interval, 1.65-2.50) but not mortality (odds ratio = 0.84; 95% confidence interval, 0.69-1.02) were higher in the stented cohort. Assessing trends over the 2 years after stent placement, the incremental risk for MI decreased from 5% immediately after stent placement to 2% at 1 year and then was no longer significantly elevated. The incremental risk did not vary by stent type. Conclusions: Surgery after coronary stent placement is associated with an approximate 2% absolute risk for postoperative MI but no difference in mortality compared with nonstented matched controls.

Original languageEnglish (US)
Pages (from-to)924-930
Number of pages7
JournalAnnals of surgery
Volume263
Issue number5
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

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Stents
Cohort Studies
Myocardial Infarction
Odds Ratio
Confidence Intervals
Myocardial Revascularization
Mortality
Quality Improvement
Ambulatory Surgical Procedures
Population
Heart Diseases
Logistic Models

Keywords

  • Coronary revascularization
  • Coronary stent
  • Myocardial infarction
  • Noncardiac surgery
  • Postoperative events

ASJC Scopus subject areas

  • Surgery

Cite this

The incremental risk of coronary stents on postoperative adverse events. A matched cohort study. / Holcomb, Carla N.; Graham, Laura A.; Richman, Joshua S.; Itani, Kamal M.F.; Maddox, Thomas M.; Hawn, Mary T.

In: Annals of surgery, Vol. 263, No. 5, 01.01.2016, p. 924-930.

Research output: Contribution to journalReview article

Holcomb, Carla N. ; Graham, Laura A. ; Richman, Joshua S. ; Itani, Kamal M.F. ; Maddox, Thomas M. ; Hawn, Mary T. / The incremental risk of coronary stents on postoperative adverse events. A matched cohort study. In: Annals of surgery. 2016 ; Vol. 263, No. 5. pp. 924-930.
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abstract = "Objective: To determine the incremental risk of coronary stents on adverse events in surgical patients and whether it varies over time from stent placement. Background: Postoperative adverse cardiac events decrease as the time from stent placement increases, but the risk attributable to the stent versus the underlying cardiac disease is uncertain, as prior studies lack a control surgical population. Methods: Data for patients with coronary stents implanted in a VA hospital from 2000 to 2010 were matched with VA Surgical Quality Improvement Program data to identify noncardiac surgery within 24 months of stent placement. Each patient with stent was matched with 2 surgical patients without stent on surgical characteristics and cardiac risk factors. Outcomes of myocardial infarction (MI), revascularization, and death within 30 days after surgery were modeled using logistic regression. Adjusted risk differences between stented and nonstented populations were compared across time after stent placement. Results: Adverse cardiac events followed surgery in 531 (5.7{\%}) of the 9391 patients with stent and 680 (3.6{\%}) of the 18,782 patients without stent (P < 0.001). In adjusted models, 30-day postoperative MI (odds ratio = 1.90; 95{\%} confidence interval, 1.57-2.30) and revascularization (odds ratio = 2.03; 95{\%} confidence interval, 1.65-2.50) but not mortality (odds ratio = 0.84; 95{\%} confidence interval, 0.69-1.02) were higher in the stented cohort. Assessing trends over the 2 years after stent placement, the incremental risk for MI decreased from 5{\%} immediately after stent placement to 2{\%} at 1 year and then was no longer significantly elevated. The incremental risk did not vary by stent type. Conclusions: Surgery after coronary stent placement is associated with an approximate 2{\%} absolute risk for postoperative MI but no difference in mortality compared with nonstented matched controls.",
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T1 - The incremental risk of coronary stents on postoperative adverse events. A matched cohort study

AU - Holcomb, Carla N.

AU - Graham, Laura A.

AU - Richman, Joshua S.

AU - Itani, Kamal M.F.

AU - Maddox, Thomas M.

AU - Hawn, Mary T.

PY - 2016/1/1

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N2 - Objective: To determine the incremental risk of coronary stents on adverse events in surgical patients and whether it varies over time from stent placement. Background: Postoperative adverse cardiac events decrease as the time from stent placement increases, but the risk attributable to the stent versus the underlying cardiac disease is uncertain, as prior studies lack a control surgical population. Methods: Data for patients with coronary stents implanted in a VA hospital from 2000 to 2010 were matched with VA Surgical Quality Improvement Program data to identify noncardiac surgery within 24 months of stent placement. Each patient with stent was matched with 2 surgical patients without stent on surgical characteristics and cardiac risk factors. Outcomes of myocardial infarction (MI), revascularization, and death within 30 days after surgery were modeled using logistic regression. Adjusted risk differences between stented and nonstented populations were compared across time after stent placement. Results: Adverse cardiac events followed surgery in 531 (5.7%) of the 9391 patients with stent and 680 (3.6%) of the 18,782 patients without stent (P < 0.001). In adjusted models, 30-day postoperative MI (odds ratio = 1.90; 95% confidence interval, 1.57-2.30) and revascularization (odds ratio = 2.03; 95% confidence interval, 1.65-2.50) but not mortality (odds ratio = 0.84; 95% confidence interval, 0.69-1.02) were higher in the stented cohort. Assessing trends over the 2 years after stent placement, the incremental risk for MI decreased from 5% immediately after stent placement to 2% at 1 year and then was no longer significantly elevated. The incremental risk did not vary by stent type. Conclusions: Surgery after coronary stent placement is associated with an approximate 2% absolute risk for postoperative MI but no difference in mortality compared with nonstented matched controls.

AB - Objective: To determine the incremental risk of coronary stents on adverse events in surgical patients and whether it varies over time from stent placement. Background: Postoperative adverse cardiac events decrease as the time from stent placement increases, but the risk attributable to the stent versus the underlying cardiac disease is uncertain, as prior studies lack a control surgical population. Methods: Data for patients with coronary stents implanted in a VA hospital from 2000 to 2010 were matched with VA Surgical Quality Improvement Program data to identify noncardiac surgery within 24 months of stent placement. Each patient with stent was matched with 2 surgical patients without stent on surgical characteristics and cardiac risk factors. Outcomes of myocardial infarction (MI), revascularization, and death within 30 days after surgery were modeled using logistic regression. Adjusted risk differences between stented and nonstented populations were compared across time after stent placement. Results: Adverse cardiac events followed surgery in 531 (5.7%) of the 9391 patients with stent and 680 (3.6%) of the 18,782 patients without stent (P < 0.001). In adjusted models, 30-day postoperative MI (odds ratio = 1.90; 95% confidence interval, 1.57-2.30) and revascularization (odds ratio = 2.03; 95% confidence interval, 1.65-2.50) but not mortality (odds ratio = 0.84; 95% confidence interval, 0.69-1.02) were higher in the stented cohort. Assessing trends over the 2 years after stent placement, the incremental risk for MI decreased from 5% immediately after stent placement to 2% at 1 year and then was no longer significantly elevated. The incremental risk did not vary by stent type. Conclusions: Surgery after coronary stent placement is associated with an approximate 2% absolute risk for postoperative MI but no difference in mortality compared with nonstented matched controls.

KW - Coronary revascularization

KW - Coronary stent

KW - Myocardial infarction

KW - Noncardiac surgery

KW - Postoperative events

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