Abstract 4299: 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 (pts) undergoing sirolimus-eluting stent (SES) implantation at 37 centers. Data on surgical procedures during follow-up were prospectively collected. Surgical procedures included coronary artery bypass grafting but excluded percutaneous endovascular procedures. Complete one-year (median of 883 days; interquartile range: 632–1095 days) follow-up was achieved in 97% of pts.
Results: Cumulative incidences of surgical procedures were 0.4% at 30 days, 5.1% at 1 year, 10.2% at 2 years and 14.7% at 3 years. Common fields of surgery included gastrointestinal (23%), cardiac (22%), vascular (15%), orthopedic (12%) and ophthalmic (11%). Antiplatelet therapy just before surgical procedures were dual (28%), aspirin alone (30%), thienopyridine alone (1.3%) and none (40%). Among 1430 pts with surgical procedures during follow-up, four pts (0.3%) had definite stent thrombosis (ST) within 30 days after surgery (Table⇓). Two pts were on aspirin monotherapy and the other two pts had discontinued both antiplatelet agents. Myocardial infarction (MI) incidence was 0.7% (9 patients) at 30 days after surgery. Five of these nine MI were due to ST (4 definite and 1 probable). ST rate was significantly higher in pts undergoing surgical procedures within 90 days after SES implantation as compared with that beyond 90 days. Thirty-two pts (2.3%) died within 30 days after surgery. Although 4 of these 32 deaths were due to peri-operative MI, there was only one episode of sudden death.
Conclusions: Surgical procedures were required fairly commonly after SES implantation. Surgical procedures performed within 90 days after SES implantation carried increased risk for definite ST. However, absolute incidence of peri-operative MI was well within the acceptable range.