NEW YORK (Reuters Health) – In recipients of drug-eluting coronary stents who undergo a major noncardiac surgical procedure some months later, the risk of adverse outcomes is less than has been reported — but still increased in the week following the surgery.
That word comes from Dr. Peter B. Berger with the Geisinger Clinic in Danville, Pennsylvania, and colleagues, reporting in JACC: Cardiovascular Interventions for September.
“It is probably not an exaggeration to say that the frequent cessation of antiplatelet therapy in patients who require a surgical procedure and who have coronary disease or even worse, have recently undergone a coronary stent procedure, is a public health crisis,” Dr. Berger told Reuters Health via email.
He added, “Antiplatelet therapy can often be safely continued throughout the perioperative period, though many surgeons and proceduralists are not aware that it is safe to do so.”
The researchers analyzed data on 4637 consecutive patients who underwent placement of one or more drug-eluting stents (DESs) at 42 hospitals and were followed for 1 year.
Among this cohort, 4.4% had major noncardiac surgery at 13 to 360 days (median 179 days) after receiving their stents. Most operations (87%) were orthopedic, abdominal or vascular.
“In the first 7 days after surgery, 4 of the 206 patients (1.9%) suffered a major cardiac event: 1 died and 3 suffered an MI,” according to the report. In fact, the risk of ischemic complications was 27-times higher in the week following noncardiac surgery than in any other week after stent placement.
The timing of surgery was not significantly different in those who had a cardiac event (median, 156 days) and those who didn’t (181) days.
However, “It is often wise to delay elective surgical procedures that require cessation of antiplatelet therapy in patients who have recently received a coronary stent until the coronary artery heals, at which point the stent is at much lower risk of thrombosing, or clotting off,” Dr. Berger advised. “It is believed to take at least 6 weeks for a heart artery with a bare metal stent to heal, and 6 months or longer, perhaps even a year, for a heart artery with a drug-eluting stent to heal.”
In the study, only seven of the 4637 PCIs performed (0.15%) were indicated because a surgical procedure was planned. In such cases, though, the type of stent should be considered. “If a patient is going to need surgery in the months after receiving a stent, a bare metal stent should generally be implanted. It is not wise to place a drug- eluting stent in such patients,” Dr. Berger concluded.
Reference:
Frequency of Major Noncardiac Surgery and Subsequent Adverse Events in the Year After Drug-Eluting Stent Placement: Results From the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry
J Am Coll Cardiol Intv 2010;3:920 -927.
