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J Am Coll Cardiol, 2003; 42:234-240, doi:10.1016/S0735-1097(03)00622-3
© 2003 by the American College of Cardiology Foundation
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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{dagger}, James L. Orford, MBChB, MPH{ddagger}, 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
{dagger} Department of Cardiology, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin, USA
{ddagger} 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.

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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