Bare Metal Stenting and Noncardiac Surgery, How Long Should We Wait?

Abstract

We read with interest the article by van Kuijk et al 1 van Kuijk J.P. Flu W.J. Schouten O. Hoeks S.E. Schenkeveld L. de Jaegere P.P. Bax J.J. van Domburg R.T. Serruys P.W. Poldermans D. Timing of noncardiac surgery after coronary artery stenting with bare metal or drug-eluting stents. Am J Cardiol. 2009; 104: 1229-1234 Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar recently published in the Journal that raises important questions regarding the best intervals between coronary stenting and noncardiac surgery. The authors suggest that instead of waiting 4 to 6 weeks after bare metal stenting, as currently recommended in the American Heart Association/American College of Cardiology guidelines, 2 Fleisher L.A. Beckman J.A. Brown K.A. Calkins H. Chaikof E. Fleischmann K.E. Freeman W.K. Froehlich J.B. Kasper E.K. Kersten J.R. Riegel B. Robb J.F. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol. 2007; 50: e159-e242 Abstract Full Text Full Text PDF PubMed Scopus (430) Google Scholar we should ideally postpone surgery for 90 days, when the risk of major cardiac events are expected to be lower. However, prolonging by 45 to 60 days the interval between procedures might not be harmless, even for elective procedures. The prognosis of the underlying disease that requires surgical treatment could be affected in some circumstances, such as in oncologic patients, when waiting has more than psychological consequences. Timing of Noncardiac Surgery After Coronary Artery Stenting With Bare Metal or Drug-Eluting StentsAmerican Journal of CardiologyVol. 104Issue 9PreviewThe current guidelines have recommended postponing noncardiac surgery (NCS) for ≥6 weeks after bare metal stent (BMS) placement and for ≥1 year after drug-eluting stent (DES) placement. However, much debate has ensued about these intervals. The aim of the present study was to assess the influence of different intervals between stenting and NCS and the use of dual antiplatelet therapy on the occurrence of perioperative major adverse cardiac events (MACEs). We identified 550 patients (376 with a DES and 174 with a BMS) by cross-matching the Erasmus Medical Center percutaneous coronary intervention (PCI) database with the NCS database. Full-Text PDF ReplyAmerican Journal of CardiologyVol. 105Issue 7PreviewWe thank the authors for their comments on our research paper about the timing of noncardiac surgery (NCS) after bare metal stenting (BMS). In daily practice, a clinical decision is determined from the balance between benefits and harms, according to the historical adagio: “Primum non nocere.” The importance of a continuous evaluation of the double-edged sword on the timing of NCS and the antiplatelet regimen must be accentuated. From the results of our study,1 we have recommended postponing surgery, preferably until 90 days after BMS, instead of waiting 4 to 6 weeks as recommended in the American Heart Association/American College of Cardiology guidelines. Full-Text PDF