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.
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 […]