When Can Patients with New Stents Undergo Surgery?

Authors: Spaulding C and Mennuni MG., J Am Coll Cardiol 2016 Dec 20; 68:2633

A study of Danish registry data suggests that a delay of a year may be unnecessary.

Current guidelines recommend delaying noncardiac surgery for at least 6 months after percutaneous coronary intervention to insert a drug-eluting stent (DES). By linking government registries, Danish investigators identified 4303 patients who underwent DES between 2005 and 2012 and who had a surgical procedure within the year. The comparison group included 20,232 surgical patients without ischemic heart disease, matched to the DES patients by age, sex, and surgical characteristics.

About 60% of patients received a first-generation DES, and 56% had an acute coronary syndrome. More DES patients than controls had comorbidities. Surgery in the DES group was more common within the first 3 months than in the next 3 quarters. Compared with surgery at 9 to 12 months postimplantation, surgery within the first month (but not beyond then) was associated with significantly increased risk for myocardial infarction, cardiac death, and all-cause mortality. Overall, surgery in DES patients was associated with higher risks for myocardial infarction and cardiac death than in controls. The highest risks for events were associated with timing of surgery, emergency surgery, peripheral arterial disease, renal disease, and acute coronary syndromes as an indication for DES. No information was provided on antiplatelet use during the surgical procedures.

Comment The current advice to delay elective noncardiac surgery after DES implantation often presents a challenge for the consulting cardiologist when both patient and surgeon are anxious to proceed with surgery. Data from this single registry are not strong enough to change clinical practice but do provide some comfort to cardiologists that surgery can probably be given the okay 1 month after DES implantation.