Noncardiac Surgery After Coronary Revascularization
More Contemporary Evidence Needed
Although largely based on expert opinion and limited by paucity of data, current guidelines recommend that elective surgery after percutaneous coronary intervention (PCI) with implantation of a drug-eluting stent should be delayed until completion of 1 year of dual antiplatelet therapy (APT) to avoid the risk of adverse cardiac events.1 Recent data have challenged this recommendation, and timing of surgery beyond 6 months after stent implantation may not affect the risk for adverse outcomes in those undergoing noncardiac surgery.2 In this issue of Circulation: Cardiovascular Interventions, Tokushige et al3 in a retrospective analysis of the Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/coronary artery bypass grafting (CABG) registry cohort 2, now add to the evidence describing outcomes in patients undergoing noncardiac surgery after coronary revascularization.3
Article see p 482
Consecutive patients were enrolled in the CREDO-Kyoto PCI/CABG registry cohort 2 after first coronary revascularization among 26 centers in Japan between January 2005 and December 2007. In this analysis, the authors compared the incidence and outcomes of surgical procedures between the PCI and CABG groups. Timing of surgery from the time of coronary revascularization was classified as early (within 42 days) and late (beyond 42 days). Primary ischemic (death or myocardial infarction) and primary bleeding (moderate or severe bleeding by the Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries classification) outcomes were assessed at 30 days after the noncardiac surgical procedure.
Perhaps, as expected, surgical procedures were performed more frequently after CABG than after PCI (cumulative 3-year incidence, 27% versus 22%; unadjusted P<0.0001). This observation was largely …