Table 10

Studies Reporting the Clinical Outcome (Death or Nonfatal MI) of Patients Undergoing Noncardiac Surgery After PCI

Study AuthorsYear PublishedNo. of Patients Who Underwent PCITime From PCI to SurgeryPerioperative Mortality, %Perioperative Infarction, %Comments
PCI Without Stents (Coronary Balloon Angioplasty)
 Allen et al. (304)1991148338 d (mean)2.70.7No increase in events if surgery performed within 90 d of PTCA.
 Huber et al. (305)1992509 d (mean)1.95.6CABG needed after balloon angioplasty in 10% of patients; no control group for comparison.
 Elmore et al. (306)19931410 d (mean)00%Very small study. Event rate in patients treated with CABG or balloon angioplasty less than in control group. Angioplasty patients had fewer risk factors than patients undergoing CABG.
 Gottleib et al. (307)199819411 d (median)0.50.5Only vascular surgeries included.
 Posner et al. (308)19996861 year (median)2.62.2Patients who had undergone PCI had a similar frequency of death and MI but half the angina and HF as matched patients with CAD who had not undergone PCI. Event rates were much higher if PCI had been performed within 90 d.
 Brilakis et al. (309)2005350Within 2 months0.30.6All events occurred in patients who underwent surgery within 2 weeks of PTCA.
 Leibowitz et al. (310)2006216
  • Early (0 to 14 d)

  • Late (15 to 62 d)

19 114.77.2
  • 56% had balloon angioplasty

  • 44% had stents. No outcome difference between balloon angioplasty and stent groups.

PCI With Coronary Stents
 Kaluza et al. (311)20004013 d (mean)2016.8Mortality was 32% among patients operated on less than 12 d after stent placement versus 0 in patients operated on 12 to 30 d after PCI.
 Hassan et al. (312)200125129 months (median)0.80.8Among patients who received PCI in BARI, outcome after noncardiac surgery was equivalent to that of BARI patients who had received CABG.
 McFalls et al. (143)200422554 d (median)3.1 (revascularization) vs. 3.4% (control)11.6 (revascularization) vs. 14.3% (control)Patients randomized to coronary revascularization (PCI in 59%, CABG in 41%) or not before vascular surgery. No difference in short- or long-term risk of MI or death.
 Godet et al. (313)2005785 to 8 weeks49Propensity analysis showed no benefit for preoperative revascularization.
 Vicenzi et al. (314)200610312 months512Mix of bare-metal and drug-eluting stents. Cardiac risk within 35 d of stent implantation was increased 2.1-fold compared with after 35 d.
 Schouten et al. (315)2007192
  • Early

  • Late

  • 13.3

  • 0.6

  • 0

  • 0

Early surgery: 13.3% had MACE; late surgery: 0.6% had MACE. Early surgery and no thienopyridine: 30.7% had MACE.
 Poldermans et al. (300)2007
  • 32 PCI

  • 17 CABG

31 d22.5 at 30 d34.7 at 30 dHigh-risk patients with significant CAD randomized to revascularization versus medical therapy. No advantage to revascularization in primary end point at 30 d or 1 year.

BARI indicates Bypass Angioplasty Revascularization Investigation; CAD, coronary artery disease; CABG, Coronary artery bypass surgery; HF, heart failure; MACE, major adverse cardiovascular event(s); MI, myocardial infarction; PCI, percutaneous coronary intervention; and PTCA, percutaneous transluminal coronary angioplasty.