Catastrophic outcomes of noncardiac surgery soon after coronary stenting

OBJECTIVES To assess the clinical course of patients who hive undergone cor onary stent placement less than six weeks before noncardiac surgery. BACKGROUND Surgical and percutaneous transluminal coronary angioplasty reva scularization performed before high-risk noncardiac surgery is expected to reduce perioperative cardia: morbidity and mortality. Perioperative and pos toperative complications in patients who have undergone coronary stenting b efore a noncardiac surgery have not been studied. METHODS Forty patients who underwent coronary stent placement less than six weeks before noncardiac surgery requiring a general anesthesia were includ ed in the study (1-39 days, average: 13 days). The records were screened fo r the occurrence of adverse clinical events, including myocardial infarctio n, stent thrombosis, peri- and postoperative bleeding and death. RESULTS In 40 consecutive patients meeting the study criteria, there were s even myocardial infarctions (MIs), 11 major bleeding episodes and eight dea ths. hu deaths and MIs, as well Is 8/11 bleeding episodes, occurred in pati ents subjected to surgery fewer than 14 days from stenting. Four patients e xpired after undergoing surgery one day after stenting. Based on electrocar diogram, enzymatic and angiographic evidence, stent thrombosis accounted fo r most of the fatal events. The time between stenting and surgery appeared to be the main determinant of outcome. CONCLUSIONS Postponing elective noncardiac surgery for two to four weeks af ter coronary stenting should permit completion of the mandatory antiplatele t regimen, thereby reducing the risk of stent thrombosis and bleeding compl ications. (J Am Coil Cardiol 2000;35:1288-94) (C) 2000 by the American Coll ege of Cardiology.