P ercutaneous coronary intervention (PCI) is the most common strategy for myocardial revascularization and in the vast majority of the cases is accomplished with coronary stenting. To prevent the occurrence of stent thrombosis and its serious clinical consequences, dual antiplatelet therapy is recommended for at least 1 month after bare-metal stent (BMS) implantation and for 6 to 12 months after drug-eluting stent (DES) implantation. [1][2][3] This different therapeutic approach is because of delayed endothelialization associated with DES, a phenomenon that extends the time window for the risk of stent thrombosis.Among patients who receive coronary stents, a considerable proportion subsequently need surgery, 4,5 and this represents a risk factor for both ischemic and bleeding events, Background-Epidemiology and consequences of surgery in patients with coronary stents are not clearly defined, as well as the impact of different stent types in relationship with timing of surgery. Methods and Results-Among 39 362 patients with previous coronary stenting enrolled in a multicenter prospective registry and followed for 5 years, 13 128 patients underwent 17 226 surgical procedures. The cumulative incidence of surgery at 30 days, 6 months, 1 year, and 5 years was 3.6%, 9.4%, 14.3%, and 40.0%, respectively, and of cardiac and noncardiac surgery was 0.8%, 2.1%, 2.6%, and 4.0% and 1.3%, 5.1%, 9.1%, and 31.7%, respectively. We assessed the incidence and the predictors of cardiac death, myocardial infarction, and serious bleeding event within 30 days from surgery. Cardiac death occurred in 438 patients (2.5%), myocardial infarction in 256 (1.5%), and serious bleeding event in 1099 (6.4%). Surgery increased 1.58× the risk of cardiac death during follow-up. Along with other risk factors, the interplay between stent type and time from percutaneous coronary intervention to surgery was independently associated with cardiac death/ myocardial infarction. In comparison with bare-metal stent implanted >12 months before surgery, old-generation drugeluting stent was associated with higher risk of events at any time point. Conversely, new-generation drug-eluting stent showed similar safety as bare-metal stent >12 months and between 6 and 12 months and appeared trendly safer between 0 and 6 months. with an inverse relationship with time. 6 Indeed, premature cessation of dual antiplatelet therapy is a strong predictor of stent thrombosis, and surgery is a common reason for premature discontinuation of either single or dual antiplatelet therapy (DAPT) antiplatelet therapy. 7 The hypercoagulable state associated with surgery can further contribute to increase the overall ischemic risk. On the opposite front, continuation of antiplatelet therapy may increase the risk of perioperative bleeding. 8 The risk of perioperative complications, however, depends also on other factors, including patient status, type, and magnitude of surgery and prevalence of comorbidities.
Conclusions-Surgery
3Cardiac risk, therefore, extends well beyond the recommende...
