Impact of Coronary Artery Stenting on Perioperative Mortality and Complications in Patients Undergoing Pancreaticoduodenectomy.

Abstract

Introduction: Postoperative morbidity and mortality from pancreaticoduodenectomy have dropped significantly, allowing for greater consideration of patients with severe comorbidities. The aim of this study was to evaluate the impact of prior coronary artery intervention on morbidity and mortality in patients undergoing pancreaticoduodenectomy.

Methods: Patients who underwent pancreaticoduodenectomy were identified from the ACS-NSQIP database. Patients with prior coronary artery intervention received either balloon dilatation or stent placement. Main outcome measures included in-hospital mortality and postoperative myocardial infarction.

Results: Of 10,848 patients that underwent pancreaticoduodenectomy, 698 (6.4%) received prior coronary artery intervention. Patients with prior coronary artery intervention were older (70 vs. 65 years, p<0.001), more frequently male (26.4% vs. 50.2%, p<0.001), and had higher median BMI (27 vs. 26, p=0.003). Patients in the angioplasty/stent cohort were more likely to have diabetes (39.3% vs. 22.0%), functional impairment (4.9% vs. 2.4%), COPD (8.2% vs. 4.1%), hypertension (86.2% vs. 51.2%), and bleeding disorders (8.0% vs. 2.2%) (all p<0.001). Patients in the stent/angioplasty group were more likely to have postoperative complications (51.4% vs. 41.0%, p<0.001). Prior stent/angioplasty procedure (OR 2.61, 95% CI 1.42-4.57, p=0.001) was associated with developing postoperative MI but was not an independent predictor of in-hospital mortality (OR 1.19, 95% CI 0.81-1.70; p=0.369).

Conclusions: Prior stent placement/angioplasty was not associated with increased in-hospital mortality in patients who underwent pancreaticoduodenectomy, despite being correlated with increased risk of MI and severe complications. Prior coronary artery angioplasty and/or stenting is not an absolute contraindication for pancreaticoduodenectomy, but patients should be medically optimized preoperatively to mitigate risk of major adverse cardiac events.