Original title: Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents. Reference: Hawn MT et al. JAMA 2013;DOI:10.1001
In the patients who underwent non cardiac surgery and had coronary angioplasty with stent history within 2 years there was not increased in major cardiac events (MACE ) with the exception of those who were operated on emergency or had advanced heart disease. In contrast those who received angioplasty at least 6 months prior to surgery showed no increased risk of MACE beyond the type of stent used.
Currently guides suggest waiting at least 6 weeks for the case of a conventional stent and a year after a drug-eluting stent (DES) but according to this study, both stents have an increased risk at the beginning and for both stents the risk reaches base at 6 months. This study is a multicenter retrospective analysis ( Veterans Affairs and Centers for Medicare and Medicaid Services) that included 41989 patients. Between 2000 and 2010 patients 124844 patients were treated with stents, of which 22.5 % were undergoing noncardiac surgery within 2 years. For those who underwent surgery within the first 6 weeks after angioplasty MACE rate was 11.6 % for those operated between 6 weeks and 6 months MACE rate was 6.4 %. Between 6 months and a year and between the first year and the second; the MACE rate was 4.2 % and 3.5 % respectively. The risk of events was also different between patients receiving drug-eluting stents versus bare-metal stents (5.1% versus 4.3 % respectively, p < 0.001 ). However on multivariate analysis only admission for emergency surgery , history of stroke within 6 months after surgery and low cardiac index were predictors of MACE. Of course it is a retrospective registry and this is a major limitation of the study.
Conclusion:
In patients who undergo noncardiac surgery within 2 years of coronary angioplasty with stent we only observed increased risk of events in those with emergency surgery or advanced heart disease but no difference with respect to the type of stent or at the time of the surgery if this was done at least 6 months later. The emphasis of the guidelines on the stent type and surgical time for drug-eluting stents and conventional, should be reevaluated
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