How long should patients wait after a coronary stent, before safely undergoing non-cardiac surgery? In 2 recent observational studies from Mayo, researchers evaluated the risk of perioperative cardiac events (death, MI, stent thrombosis, or repeat revascularization) in patients with bare-metal or drug-eluting stents. Of the 899 with bare-metal stents, the adjusted risk of an in-hospital event was 10.5% (< 1 month post stent), 3.8% (1-3 months), and 2.8% (3+months) (Nuttall et al). Of the 520 with drug-eluting stents, the adjusted risk of an in-hospital perioperative event was approximately 6% (< 1 year post stent) and 3.3% (1-2 years) (Rabbitts et al). These data indicate non-cardiac surgery should delayed at least a month for bare metal stents and at least a year for drug eluting stents, which is consistent with recommendations from the ACC/AHA (Guidelines). If surgery cannot be delayed, these statistics can at least help us objectively evaluate the risks and benefits of our perioperative recommendations.
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