title: Management of patients with cardiac stents undergoing noncardiac surgery.
abstract: OBJECTIVE
  Coronary stenting is performed in over 4 million patients annually. Approximately 5% of these patients undergo a noncardiac surgical procedure within 1 year after stenting. Surgery might induce hypercoagulability. This causes increased concern about the effects of previous coronary stenting on postoperative cardiac outcome, particularly in-stent thrombosis. On the other hand, patients with multiple cardiac risk factors are at high risk for postoperative adverse cardiac events and might even benefit from preoperative prophylactic coronary revascularization.
  
  
  RESULTS
  Early noncardiac surgery after coronary stent placement is associated with an increased risk of major adverse cardiac events. The majority of these events are attributable to in-stent thrombosis. Antiplatelet therapy interruption in the perioperative period seems to be associated with an increase in adverse cardiac events, particularly in patients who undergo noncardiac surgery early after coronary stenting. Furthermore, prophylactic coronary revascularization for high cardiac risk patients is not associated with an improved outcome.
  
  
  CONCLUSIONS
  Early noncardiac surgery after coronary stenting increases the risk of postoperative cardiac events. Interruption of antiplatelet therapy seems to play an important role in this increased event rate. Prophylactic coronary revascularization in cardiac stable, but high-risk patients does not seem to improve outcome.
authors.affiliation: Department of Vascular Surgery, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000758:Anesthesia; D006801:Humans; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011300:Preoperative Care; D015607:Stents; D013514:Surgical Procedures, Operative
chemical_list: D010975:Platelet Aggregation Inhibitors