This cohort study determined the risk of major peri-operative adverse cardiac events (death, MI, repeat revascularization) in patients undergoing non-cardiac surgery after the placement of a bare metal or drug eluting stent. They found the risks of major adverse events after bare metal stenting were 50%, 14%, and 4% (<1month, 1month-3months, and >3months, respectively). Risks after drug eluting stenting were 35%, 13%, 15%, 6%, and 9% (<1month, 1-3months, 3-6months, 6-12months, and >12months). Of the patients that experienced an adverse cardiac event, all were on anti-platelet therapy (45% on single agent, 55% on dual agent). Risks of cardiac events after non-cardiac surgery are substantial in the time after a stent, even in patients on dual anti-platelet therapy (abstract). Non-cardiac surgery should be deferred as long as feasible in patients post-stent (at least 1.5 months for bare metal stents, and at least 1 year for drug eluting stents), which is in line with current practice guidelines.
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.