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Risks from Surgery Soon After Stenting
Angioplasty and, now, stent implantation frequently are performed before noncardiac surgery to reduce perioperative cardiac morbidity and mortality. In this study, researchers assessed the perioperative risk in 40 consecutive patients (27 men, 13 women; mean age, 67) who required general anesthesia within 6 weeks of coronary stent placement. Subjects exhibited a variety of cardiac risk factors, including unstable angina in 13 (33 percent).
Forty-seven stents were placed in 44 target vessels an average of 13 days (range, 1 to 39) before surgery. Surgical procedures included carotid endarterectomy (12 patients), aortic aneurysm resection (9), and peripheral vascular surgery (5). There were 8 deaths (6 related to MI) within 11 days of noncardiac surgery; 1 additional patient suffered a nonfatal MI. Analysis of patients' diseased arteries and MI locations suggested that stent thrombosis caused all of the MIs. The incidence of death and MI was significantly higher among patients who underwent surgery within 14 days of stenting than among those who underwent surgery more than 14 days after the procedure. Discontinuation of ticlopidine or aspirin appeared to contribute to some of the adverse events.
Comment: In this study, patients undergoing noncardiac surgery within 2 weeks of intracoronary stent placement experienced an extraordinarily high rate of cardiac events. This finding differs from that of previous studies on balloon angioplasty, a procedure that appears to reduce the risk for perioperative complications in some patients. Discontinuing antiplatelet therapy may have contributed to early subacute thrombosis in the present study, but such therapy is known to increase the risk for perioperative bleeding. Postponing elective noncardiac surgery for 2 to 4 weeks after stent implantation seems prudent.
— HC Herrmann
Published in Journal Watch Cardiology June 2, 2000
Citation(s):
Kaluza GL et al. Catastrophic outcomes of noncardiac surgery soon after coronary stenting. J Am Coll Cardiol 2000 Apr 35 1288-1294.
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