The Dangers of Surgery after Stenting

In a new article the risks of non-cardiac surgery from within 6 weeks up to a year after placement of a coronary artery stent are discussed. The authors conclude that other surgery can be quite dangerous, presumably because medications, needed to keep the stent open, have to be stopped to avoid the risk of bleeding during the procedure.

It has been known for years that improving the blood flow to the heart does not protect a patient from a heart attack or death because of a myocardial infarction (MI), except in some patients who have undergone successful coronary bypass surgery, as opposed to a stent.

It now appears that while a coronary artery stent does not protect a patient, it actually increases these dangers.

Intuitively one would have expected otherwise, namely that with blood flow to the heart improved or restored back to normal, the stress of an operation would be much better tolerated than before stenting. Since the opposite appears to be true, one wonders what the benefits are besides some relief of symptoms for a limited period of time.

Reference:

1. 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.
2. Recent Stent Makes Non-Cardiac Surgery Much Riskier, Monday May 10, 2010, By Richard N. Fogoros, M.D., (http://heartdisease.about.com/b/2010/05/10/recent-stent-makes-non-cardiac-surgery-much-riskier.htm)
3. Increased perioperative risk of death/ischemic events in stent patients undergoing noncardiac surgery, May 4, 2010 by Michael O’Riordan (http://www.theheart.org/article/1074129.do)

Please let me know what you think,

Dr T