Table 10

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

Study, YearNo. of Patients Who Underwent PCITime From PCI to SurgeryPerioperative Mortality, %Perioperative Infarction, %Comments
PCI without stents (coronary balloon angioplasty)
 Allen et al (308), 1991148338 days (mean)2.70.7No increase in events if surgery performed within 90 days of PTCA
 Huber et al (309), 1992509 days (mean)1.95.6CABG needed after balloon angioplasty in 10% of patients; no control group for comparison
 Elmore et al (310), 19931410 days (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
 Gottlieb et al (311), 199819411 days (median)0.50.5Only vascular surgeries included
 Posner et al (312), 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 days
 Brilakis et al (313), 2005350Within 2 months0.30.6All events occurred in patients who underwent surgery within 2 weeks of PTCA
 Leibowitz et al (314), 2006216Early (0 to 14 days)194.756% had balloon angioplasty. 44% had stents. No outcome difference between balloon angioplasty and stent groups
Late (15 to 62 days)117.2
PCI with coronary stents
 Kaluza et al (315), 20004013 days (mean)2016.8Mortality was 32% among patients operated on less than 12 days after stent placement vs 0 in patients operated on 12 to 30 days after PCI
 Hassan et al (316), 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 days (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 (317), 2005785 to 8 weeks49Propensity analysis showed no benefit for preoperative revascularization
 Vicenzi et al (318), 200610312 months512Mix of bare-metal and drug-eluting stents. Cardiac risk within 35 days of stent implantation was increased 2.1-fold compared with after 35 days
 Schouten et al (319), 2007192Early13.30Early surgery: 13.3% had MACE; late surgery: 0.6% had MACE. Early surgery and no thienopyridine: 30.7% had MACE
 Poldermans et al (304), 200732 PCI 17 CABG31 days22.5 at 30 days34.7 at 30 daysHigh-risk patients with significant CAD randomized to revascularization vs medical therapy. No advantage to revascularization in primary end point at 30 days 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; PTCA, percutaneous transluminal coronary angioplasty.