Timing of Noncardiac Surgery in Patients with Coronary Stents

According to current guidelines, noncardiac surgery should be delayed for 6 weeks after bare-metal stent (BMS) implantation and for 1 year after drug-eluting stent (DES) implantation. To examine the associations of stent type and time from stent to surgery with major adverse cardiac events (MACE; a composite of myocardial infarction [MI], revascularization, and all-cause mortality), investigators retrospectively studied outcomes of 41,989 noncardiac surgical procedures in 28,029 Veterans Affairs patients within 2 years after coronary stent implantation during 2000–2010.

In all, 1980 MACE (4.7%) occurred within 30 days after surgery: 1170 nonfatal MIs or revascularizations, 141 fatal MIs or revascularizations, and 669 other deaths. The rate of MACE decreased with increasing time from stent to surgery (<6 weeks, 11.6%; 6 weeks–<6 months, 6.4%; 6–<12 months, 4.2%; 12–24 months, 3.5%). In propensity analysis, DES recipients had a significantly lower risk for MACE than BMS recipients (adjusted odds ratio, 0.87). The factors most strongly associated with MACE were nonelective surgery, ischemic cardiac disease, and high revised cardiac risk index score. No significant interaction was found between stent type and time to surgery. In a case-control analysis of 284 matched pairs, perioperative cessation of antiplatelet therapy was not associated with MACE.