A study appearing recently in Circulation: Cardiovascular Interventions shows that patients who have recently received coronary artery stents - either bare metal stents or drug-coated stents - have a much higher risk of cardiovascular complications if they have non-cardiac surgery up to a year after stent placement. The elevated risk is especially prominent for the first six weeks after stent placement.
Investigators from Edinburgh, Scotland studying data from the Scottish Coronary Revascularization Register, found over 1900 patients who had received stents and then went on to have non-cardiac surgery (such as orthopedic procedures, cosmetic surgery, or gastrointestinal surgery). They found that, whether the stents were drug-coated or not, serious cardiovascular complications - including heart attack or death - were seen in 42.4% of patients if the non-cardiac surgery was done within six weeks of stent placement, and in 14.5% of patients if surgery was done within one year.
While the precise cause of this increased risk is not fully known, presumably it has to do with the need to stop therapy with Plavix and other "blood thinners" in order to do the surgery, which may allow blood clots to form on the stent, thus blocking the coronary artery.
The investigators point out that their study is relatively small, and it is also a retrospective study, so it will likely not lead to a change in official guidelines about stent placement and surgery.
However, the high observed incidence of serious complications after post-stent surgery ought to make you and your doctor take notice. Unless your proposed stent is being placed on an emergency or semi-emergency basis (that is, in the treatment of acute coronary syndrome), you and your doctor need to fully discuss any foreseeable need for surgery during the next year, before deciding on whether a stent at this particular time is the best option.
Since the need for subsequent surgery is not always predictable, this new study should be one more reason for you and your doctor to have a long talk about all the options for treating coronary artery disease, and not defaulting immediately to stents.
Sources:
Cruden NL, Harding SA, Flapan AD, et al. Prior coronary stent implantation and cardiac events in patients undergoing noncardiac surgery. Circ Cardiovasc Interv 2010; in press. Available at: http://circinterventions.ahajournals.org.
