title: Contemporary approaches to perioperative management of coronary stents and to preoperative coronary revascularization: a survey of 374 interventional cardiologists.
abstract: BACKGROUND
  We sought to assess contemporary approaches of interventional cardiologists to preoperative evaluation and perioperative management of coronary stents.
  
  
  METHODS
  Online survey sent in December 2008 to 3771 US interventional cardiologists (10% completion rate).
  
  
  RESULTS
  Patients with coronary stents needing noncardiac surgery are frequently encountered: 49% and 30% of the cardiologists saw two to four and five or more such patients, respectively, every month. The majority of participants recommended (a) ≥6 weeks delay as optimal for surgery after bare metal stent implantation; (b) continuing dual antiplatelet therapy in stent patients undergoing minor bleeding risk procedure; (c) avoiding drug-eluting stent implantation in patients known to need noncardiac surgery within 12 months from percutaneous coronary intervention; (d) treating perioperative stent thrombosis with primary percutaneous coronary intervention; and (e) performing nuclear stress testing in stable patients who need major noncardiac surgery. There was equipoise in the need for "bridging" with glycoprotein IIb/IIIa inhibitors in patients needing early surgery after drug-eluting stent implantation.
  
  
  CONCLUSIONS
  Interventional cardiologists frequently treat patients who require surgery after stent implantation. Although agreement exists on the optimum delay for surgery after stenting, on the need for bare metal stents or balloon angioplasty alone if early noncardiac surgery is needed, and on the treatment of perioperative stent thrombosis, there is divergence of opinion on the need for preoperative stress testing and on the "bridging" therapy for patients who need surgery early after stent implantation.
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Tarif
authors.initials: T
authors.lastname: Khair
authors.forename: Bobby
authors.initials: B
authors.lastname: Garcia
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D002309:Cardiology / Q000592:standards; D054855:Drug-Eluting Stents; D019538:Health Care Surveys; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008670:Metals; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000592:standards; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents / Q000592:standards; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D008670:Metals; D010975:Platelet Aggregation Inhibitors