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By Lisa Rapaport
(Reuters Health) – An American study suggests that patients who undergo a percutaneous coronary intervention (PCI) procedure to restore blood flow to the heart are at greater risk of complications in noncardiac surgery than other people.
PCI is commonly practiced in cases of ischemic heart disease or heart problems caused by narrowing of the arteries and in the so-called acute coronary syndrome, usually caused by clots or plaque in the arteries. During PCI procedures, doctors thread a thin catheter into the artery to place a tiny mesh cage called a stent at the blocking site to open the vessel and restore blood flow to the heart.
Patients who have coronary stents in place have an increased risk of heart complications during and after non-cardiac surgeries, particularly when operations are performed shortly after PCI, said Dr. Nathaniel Smilowitz of the NYU School of Medicine, author study. This is why the clinical guidelines recommend that, where possible, surgical procedures be deferred for at least one year after the ICP.
But some research suggests that up to 7.5% of patients need to be operated on in the first six months of the ICP and that 20% of them are operated within two years, note Smilowitz and his colleagues in the American Heart Journal.
This study examined data from 221,379 PKI patients. Overall, 3.5% of these patients returned to the hospital for noncardiac surgery within six months, and 41% of these cases were elective surgeries.
"This study suggests that, despite recommendations to avoid surgery the first year after stenting, approximately 30,000 patients each year in the United States could wait less than six months before an operation," Smilowitz said via email.
"Early non-cardiac surgeries after coronary stenting were associated with poor outcomes and a risk of heart attack or death by 8% during the hospital stay," Smilowitz said. "Patients and providers need to be aware of these risks and avoid this scenario as much as possible."
Of the patients who returned for noncardiac surgery within six months of discharge, 339 of them, or 4.4%, died from various causes, the study found.
The risk of death or nonfatal heart attack was higher for non-cardiac surgeries performed less than a month after the PCI was discharged.
"Patients who require coronary stents are generally elderly with other heart risk factors and many people with other chronic diseases," Smilowitz said. "These patients may also require non-cardiac surgery to treat other conditions, and in this study, vascular surgery, orthopedic surgery, and general abdominal surgery were the most common surgeries performed in the first six months after surgery. pose of a coronary stent. "
One of the reasons that a surgery may pose a risk after an ICP is that it is prescribed for anticoagulants, including aspirin, to prevent blood clots from occurring after the establishment of any kind. a stent in the arteries, said Smilowitz.
"When these agents are stopped before the operating room, inflammation associated with surgery can cause blood clots in the stent, which can cause a heart attack," Smilowitz said.
"When anticoagulants continue during non-cardiac surgery, the risk of bleeding is high, which can be life-threatening," Smilowitz said. "This balance between risk of coagulation and bleeding during and immediately after surgery makes it a particularly vulnerable period for patients with a coronary stent."
SOURCE: http://bit.ly/2HBhorx American Heart Journal, Online July 22, 2019.
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