Published Online
on April 21, 2009

A more recent version of this article appeared on June 1, 2009

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Original Article

Non-Cardiac Surgery and Bleeding after Percutaneous Coronary Intervention

Andrew C. Y. To; Guy Armstrong; Irene Zeng and Mark W. I. Webster¹

Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand

¹ E-mail: mwebster{at}adhb.govt.nz

Background—The decision on whether to implant a drug-eluting or bare metal stent during percutaneous coronary intervention (PCI) depends in part upon the perceived likelihood of the patient developing late stent thrombosis. Non-cardiac surgery and bleeding are associated with discontinuation of dual antiplatelet therapy and with increased stent thrombosis. We assessed the incidence of and predictors for subsequent non-cardiac surgery and bleeding episodes in patients who had undergone PCI.

Methods and Results—Hospital discharge coding data were used to identify all adult patients undergoing public hospital PCI in New Zealand from 1996-2001. Hospital admissions during the ensuing 5 years were analysed for non-cardiac surgery and bleeding episodes. 11151 patients (age 62±11, 30% female) underwent PCI, mainly for an acute coronary syndrome (73%). During the 5-year follow-up, 26% of the population underwent at least one non-cardiac surgical procedure (23% orthopaedic, 20% abdominal, 12% urological, 10% vascular, 35% others) and 8.6% had at least one bleeding episode either requiring or occurring during hospitalisation. Of those half were gastrointestinal, and one quarter of bleeding events required blood transfusion. The main clinical predictors of non-cardiac surgery were advanced age, prior non-cardiac surgery, osteoarthritis and peripheral vascular disease. A previous bleeding admission and age were the strongest predictors of subsequent bleeding.

Conclusions—Non-cardiac surgery is required frequently after PCI, while bleeding is less common. Prior to implanting a drug-eluting or bare metal stent, individual patient risk stratification by the interventional cardiologist should include assessment of whether there is an increased likelihood of needing non-cardiac surgery or developing bleeding.

Key Words: coronary disease • hemorrhage • myocardial infarction • stents • thrombosis