Risk of Major Adverse Cardiac Events Following Noncardiac Surgery in Patients With Coronary Stents

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights From 2014

“…2 Recent evidence from a large noncardiac surgery registry (n ¼ 41,989: 2000-2010) suggests that the risk of major adverse cardiovascular events was associated most strongly with the following 3 factors: Emergency hospital admission (odds ratio 4.77; 95% confidence interval 4.07-5.59); myocardial infarction within preceding 6 months (odds ratio 2.63; 95% confidence interval 2.32-2.98); and, a revised cardiac risk index score 42 (odds ratio 2.13; 95% confidence interval 1.85-2.44). 20 In this perioperative trial, cardiovascular mortality and morbidity were not dependent on stent type or timing of surgery beyond 6 months after stent implantation. 20 These findings challenge the current guidelines' emphasis on stent type and timing of surgery.…”

“…20 In this perioperative trial, cardiovascular mortality and morbidity were not dependent on stent type or timing of surgery beyond 6 months after stent implantation. 20 These findings challenge the current guidelines' emphasis on stent type and timing of surgery. 20,21 Although further trials are indicated, the multiple advances in stent design over the past decade will continue to make the risks of stent thrombosis in the perioperative period recede.…”

“…20 These findings challenge the current guidelines' emphasis on stent type and timing of surgery. 20,21 Although further trials are indicated, the multiple advances in stent design over the past decade will continue to make the risks of stent thrombosis in the perioperative period recede. 22,23 In cardiac surgery, the debate continues about the optimal perioperative management of platelet blockers.…”

Cardiac Risk Assessment: Decreasing Postoperative Complications

“…5,36 Recent data indicate that surgery performed 6 months after insertion of a drugeluting stent appears to present a low risk of stent thrombosis and may be safely performed after this time. 37 Patients who are undergoing a procedure that requires discontinuation of thienopyridine for five to seven days during the vulnerability period require bridging therapy with IV short-acting antiplatelet agents, such as glycoprotein IIb/IIIa inhibitors or P2Y 12 platelet inhibitors. 37 Aspirin and thienopyridine should be restarted as soon as possible after surgery.…”

“…37 Patients who are undergoing a procedure that requires discontinuation of thienopyridine for five to seven days during the vulnerability period require bridging therapy with IV short-acting antiplatelet agents, such as glycoprotein IIb/IIIa inhibitors or P2Y 12 platelet inhibitors. 37 Aspirin and thienopyridine should be restarted as soon as possible after surgery.…”