Abstract 6010: Incidence and Outcome of Surgical Procedures after Sirolimus-Eluting Stent Implantation
Background: Incidence and outcome of surgical procedures after drug-eluting stent implantation are not adequately addressed yet.
Methods: In an observational study in Japan, two-year outcomes were assessed in 12,824 patients undergoing sirolimus-eluting stent (SES) implantation at 37 centers. Data on surgical procedures during follow-up were prospectively collected. Complete one-year (median of 494 days; interquartile range: 388 – 730 days) follow-up was achieved in 96% of patients.
Results: Cumulative incidences of surgical procedures were 0.3% at 30 days, 4.2% at 1 year and 8.6% at 2 years. Common fields of surgery included gastrointestinal (26%), vascular (19%), cardiac (14%), orthopedic (13%) and ophthalmic (11%). Antiplatelet therapy just before surgical procedures were dual (32%), aspirin alone (31%), thienopyridine alone (0.8%) and none (37%). Among 793 patients with surgical procedures during follow-up, two patients (0.26%) had definite stent thrombosis within 30 days after surgery. One patient was on aspirin monotherapy and the other had discontinued both antiplatelet agents. Myocardial infarction incidence was 0.65% (5 patients) at 30 days after surgery as compared with 1.6% at 2 years in the whole patient population (Table⇓). Four of these five myocardial infarctions were due to stent thrombosis (2 definite and 2 probable). Stent thrombosis (definite/probable) rate was significantly higher in patients undergoing surgical procedures within 90 days after SES implantation Thirteen patients (1.7%) died within 30 days after surgery. Although 2 of these 13 deaths were due to myocardial infarction, there was no episode of sudden death.
Conclusions: Surgical procedures were performed commonly after SES implantation and seemed to carry increased risk for ischemic events, particularly when performed within 90 days after SES implantation. However, absolute incidence of peri-operative myocardial infarction was well within the acceptable range.