CLINICAL RESEARCH: INVASIVE AND INTERVENTIONAL CARDIOLOGY
Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting
Stephanie H. Wilson, MBBS, FRACP*,
Panayotis Fasseas, MD ,
James L. Orford, MBChB, MPH ,
Ryan J. Lennon, MS ,
Terese Horlocker, MD||,
Nina E. Charnoff, MD||,
Steven Melby, RN¶ and
Peter B. Berger, MD, FACC¶,*
* Department of Cardiology, St. Vincent’s Hospital, Darlinghurst, Australia
Department of Cardiology, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin, USA
Department of Cardiology, Mayday University Hospital, Surrey, England United Kingdom
Department of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
|| Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
¶ Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
Manuscript received June 5, 2002;
revised manuscript received April 8, 2003,
accepted April 17, 2003.
* Reprint requests and correspondence: Dr. Peter B. Berger, Division of Cardiovascular Diseases-West 16, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905, USA.
berger.peter{at}mayo.edu
OBJECTIVES: We sought to determine the frequency and timing of complications at our institution when surgery was performed within two months of coronary stent placement.
BACKGROUND: The optimal delay following coronary stent placement prior to non-cardiac surgery is unknown.
METHODS: We analyzed the Mayo Clinic Percutaneous Coronary Intervention and Surgical databases between 1990 and 2000 and identified 207 patients who underwent surgery in the two months following successful coronary stent placement.
RESULTS: Eight patients (4.0%) died or suffered a myocardial infarction or stent thrombosis. All 8 patients were among the 168 patients (4.8%, 95% confidence interval [CI] 2.1 to 9.2) undergoing surgery six weeks after stent placement; the frequency of these events ranged from 3.8% to 7.1% per week during each of the six weeks. No events occurred in the 39 patients undergoing surgery seven to nine weeks after stent placement (0%, 95% CI 0.0 to 9.0).
CONCLUSIONS: These data suggest that, whenever possible, non-cardiac surgery should be delayed six weeks after stent placement, by which time stents are generally endothelialized, and a course of antiplatelet therapy to prevent stent thrombosis has been completed.
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Abbreviations and Acronyms
| | CABG | | coronary artery bypass graft surgery | | CI | | confidence interval | | INR | | International Normalized Ratio | | MI | | myocardial infarction | | NHLBI | | National Heart, Lung, and Blood Institute | | TIMI | | Thrombolysis In Myocardial Infarction |
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