Optimal time for elective non cardiac surgery after coronary stenting

Optimal time for elective non cardiac surgery after coronary stenting is between 46 days to 180 days for bare metal stents and beyond 180 days for drug eluting stents, says a new study by Wijeysundera DN and associates [Risk of Elective Major Non-Cardiac Surgery After Coronary Stent Insertion: A Population-Based Study. Circulation. 2012;126:1355-62]. This cohort study involved over 8000 patients who had undergone elective non cardiac surgery after coronary stenting during the period 2003 to 2009. They had undergone coronary stenting within 10 years prior to the surgery. 2725 (34%) had undergone coronary stenting within two years before the surgery. 905 (33%) had received drug eluting stents. For comparison, they had 341,350 patients who had not undergone coronary revascularization. Major adverse cardiac events (MACE: mortality, readmission for acute coronary syndrome or repeat coronary revascularization) was 2.1% for the study group. When the surgery was within 45 days of stenting, the MACE rate was 6.7% for bare metal stents (BMS) and 20% for drug eluting stents (DES). In case of bare metal stent, when the interval between stenting and surgery was between 45 days and 180 days, the MACE rate was 2.6%, nearing that of intermediate risk patients who had not undergone revascularization. Event rates increased beyond 180 days in case of BMS. But in case of DES, the event rate was 1.2% beyond 180 days, nearing that of intermediate risk non revascularized patients.

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