Coronary stents: factors contributing to perioperative major adverse cardiovascular events

Area of Science:

• Cardiology
• Perioperative Medicine
• Vascular Surgery

Background:

• Patients with coronary stents face elevated risks of major adverse cardiovascular events (MACE) during non-cardiac surgery.
• Key risk factors include interruption of dual antiplatelet therapy (DAPT) and the timing of surgery after percutaneous coronary intervention (PCI).

Purpose of the Study:

• To outline optimal perioperative management strategies for patients with coronary stents undergoing non-cardiac surgery.
• To emphasize risk mitigation for stent thrombosis and MACE.

Main Methods:

• Review of current literature and guidelines on managing patients with coronary stents undergoing non-cardiac surgery.
• Focus on DAPT, timing of surgery post-PCI, anesthetic techniques, and monitoring.

Main Results:

• Interruption of DAPT is the primary risk factor for stent thrombosis and MACE. Continuation of aspirin is recommended if clopidogrel must be stopped.
• Major adverse cardiovascular events incidence is inversely related to the interval post-PCI; delaying surgery is crucial (ideally 1 year for drug-eluting stents, 6 weeks for bare-metal stents).
• Neuraxial anesthesia requires careful consideration due to epidural hematoma risk. Perioperative monitoring for ischemia/infarction and rapid intervention for stent thrombosis are essential.

Conclusions:

• Meticulous patient care and interdisciplinary communication are vital for minimizing perioperative risks.
• Adherence to DAPT protocols and appropriate surgical delay significantly improves outcomes.
• Prompt recognition and management of perioperative cardiac events, including stent thrombosis, are critical.