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.
Fill in the Blanks: Q: “The diagnosis of type 2 MI is associated with a _____ prognosis. ___% of patients will live five years after their diagnosis.” The answer is a) POOR and b) a staggering 40%. I did not know that. However, what I am aware of is the ambiguity around Type 2 MIs and […]
What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… […]
As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc. Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them. If I am […]