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.
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.