Abstract 2829: Stent-Related Cardiac Events After Non-Cardiac Elective Surgery: Drug-Eluting Stent vs. Bare Metal Stent
Background - Recent reports suggest that those receiving drug eluting stents (DES) may be at higher risk for late stent thrombosis than those with bare metal stents (BMS). This may be especially problematic in patients receiving surgery, where antiplatelet agents must be stopped. However, the incidence of adverse cardiac events related to implanted stents in patients who undergo elective non-cardiac surgery after DES implantation is not well known.
Methods and Results - We identified 118 patients who underwent elective non-cardiac surgery after DES implantation at our institution between May 2003 and February 2006. The cardiac outcomes of these patients were evaluated and compared with 62 patients who underwent the non-cardiac surgery after bare metal stent (BMS) implantation during the same period. All patients stopped antiplatelet agents 3 to 7 days before surgery. There were no differences in clinical characteristics between the 2 groups. The mean duration from stent implantation to surgery was also similar (202±176 days vs. 191±207 days for DES vs BMS, p=0.1). However, stent size was smaller and stent length was longer in the DES group (p<0.05). There were 3 patients (2.4%) in the DES group that developed postoperative cardiac events and none in the BMS group (P=0.5). One patient died due to suspected stent thrombosis and the other two had myocardial infarction due to angiographically confirmed stent thrombosis followed by successful intervention. The time interval between stent implantation and surgery in those with cardiac events was 6, 264, and 367 days, respectively.
Conclusions - Our data shows that late thrombosis after DES implantation can occur even after completion of conventional 6 months dual antiplatelet thearpy, and suggest the need for careful perioperative monitoring for symptoms and signs of cardiac ischemia in patients reciving non-cardiac surgery.