Study suggests change in guidelines for elective surgery for people with some kinds of stents
Toronto, August 20, 2012
By Leslie Shepherd
Dr. Duminda Wijeysundera
The optimal time to perform elective surgery on a patient who has received a traditional (or bare metal) stent to widen an artery in their heart is 46-180 days after implantation, according to a new study.
The time frame for major non-cardiac surgery is after 180 days for someone who received a stent coated in drugs, the study found.
Together, these findings challenge existing guidelines on when to carry out elective surgery on patients with coronary stents.
Surgeons usually wait 12 months to perform elective surgery on patients with so-called drug-eluting stents and one month for those with bare-metal stents, because of concerns that the stress of the operation may trigger a heart attack. But waiting too long is also a problem due to disease progression.
“While our results do support the recommendation to delay elective non-cardiac surgery until at least 30 to 45 days have elapsed since bare-metal-stent implantation, they further suggest that excessive delays are not helpful,” said lead author Dr. Duminda Wijeysundera, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital.
“Conversely, whereas guidelines recommend that surgery be delayed until one year after drug-eluting stent implantation, our findings instead suggest that surgery can be performed reasonably safely following a six-month delay,” said Dr. Wijeysundera, who is also an anesthesiologist at Toronto General Hospital-University Health Network and a scientist at the Institute for Clinical Evaluative Sciences.
Results of the study, which also uses data from the Cardiac Care Network on Ontario, were published online in the journal Circulation.
About 1.2 million stents are implanted every year in North America. About five per cent of patients who receive stents, about 60,000, undergo non-cardiac surgery within a year.
About St. Michael’s Hospital
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
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