Nonsurgical cardiac procedures are most common in first six months after PCI

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Within two years following PCIs, 13.3 percent of subsequent scheduled noncardiac surgical procedures were cancelled, according to an analysis of all PCIs performed at the Veterans Affairs (VA) Healthcare System from fiscal year 2000 to 2010.

Within the first six months following stent placement, 15.1 percent of patients cancelled their surgeries compared with 12.6 percent of patients who cancelled more than six months after receiving a drug-eluting stent or bare metal stent.

Lead researcher Laura A. Graham, MPH, of the Birmingham Veterans Affairs (VA) Medical Center in Alabama, and colleagues published their findings online in  JAMA Surgery on Oct. 7.

“These results are consistent with prior findings of an increased risk of cardiac events in the 6 months following PCI regardless of surgery and further support planning of elective surgery at least 6 months after PCI,” they wrote.

They noted that previous observational studies found that patients who underwent PCI more than six months after coronary stent placement had a decreased risk of postoperative adverse cardiac events. They also mentioned there was not much information on the frequency of or factors associated with surgery cancellations following PCIs.

In this study, the researchers found that cancellations were significantly more likely in patients with a bare metal stent (14.2 percent) compared with a drug-eluting stent (12.4 percent) and were most common among patients with a history of chronic kidney disease (16.6 percent) or a recent episode of congestive heart failure (16.0 percent).

Further, 6 percent of cancellations were accompanied by death or an MI diagnosis, which was significantly more likely among cancellations within the first six months following PCI (8.5 percent) compared with more than six months (4.9 percent).

There was no difference in the proportion of cancellations related to death or MI when comparing drug-eluting stents and bare metal stents (5.9 percent in each group).