Study Tallies Risk of Noncardiac Surgery After Heart Stent Placement | WPN World People News

Which heart patients receiving artery-opening stents are at highest risk for heart attack, stroke or other issues if they undergo a noncardiac surgery soon after the procedure?

A new study pinpoints two groups at especially elevated risk: those who underwent the surgery on an emergency basis, and patients with advanced forms of heart disease.

A stent is a small mesh tube, either of a bare-metal or drug-coated ("eluting") type, that is inserted into an artery to help prop it open. Doctors typically urge that patients forgo nonessential, noncardiac surgeries for at least a year after stent implantation.

In the new study, researchers analyzed 2000-2010 data from U.S. patients who underwent noncardiac surgery -- for example, knee replacement, respiratory or digestive system surgeries -- within two years of receiving a stent.

Close to 5 percent of these patients went on to have major heart problems within a month of their surgery. These problems included heart attack, death and the need for another procedure to open heart arteries.

The three major risk factors for major heart problems were: having the surgery on an emergency basis, having had a heart attack in the six months before the surgery, and having advanced heart disease.

The rate of such heart problems was about 5 percent for people who received bare-metal stents and 4.3 percent for drug-eluting stents. Drug-eluting stents, which are typically more expensive than bare-metal versions, emit medicines that help prevent artery reclosure.

The type of stent received was not associated with major heart problems occurring more than six months after stent placement.

The researchers noted that about 600,000 stenting procedures are carried out in the United States each year, and "12 to 23 percent of these patients [also] undergo noncardiac surgery within two years of coronary stent placement."

Noncardiac surgery after recent coronary stent placement is associated with increased risk of major heart problems, but delaying necessary surgery can be a dilemma for a large number of patients.

Guidelines recommend delaying noncardiac surgery in patients after coronary stent procedures for one year after drug-eluting stents and for six weeks after bare-metal stents. The evidence underlying these recommendations is limited and conflicting.

Heart expert said that decisions around the timing of noncardiac surgeries for heart patients are complicated, especially when it comes to the use of anti-clotting drugs.

Patients getting stents are usually in an age group that has lots of health issues. Some of these people will need surgery in the months that follow a stent. Withholding anti-platelet medicines after six weeks for bare-metal stents, and after six months for drug-eluting stent, is safe.

The approach for patients with bare-metal stents should not change; these patients usually can undergo surgery within six weeks after coronary stent implantation with very low risk of stent thrombosis.

Source: U.S. HealthDay News