Non-Cardiac Surgery Too Soon After Cardiac Stenting Increases Risk of Complications

According to a recent study published in Circulation: Cardiovascular Interventions (an American Heart Association journal), patients should attempt to postpone having surgeries for at least six weeks after a coronary angioplasty procedure with stenting.  Researchers found that patients who wait at least six weeks before having another surgery are less likely to develop reduced blood flow to the heart (a.k.a. heart ischemia) and heart attacks.

The study data revealed that 42 % of patients who had other surgeries within the six-week period developed these complications. Only 13 % of patients who had surgeries beyond the six-week period developed the same complications. The study focused 1,953 patients with an average age of 64 who had cardiac angioplasty with stenting between 2003 and 2007.

According to the American Heart Association:

• Over 70 percent of coronary angioplasty procedures in the United States also include stenting.
• In 2006, approximately 65 percent of PCI procedures were performed on men, and approximately 50 percent were performed on people age 65 or older.
• In 2006, an estimated 1,313,000 PCI procedures were performed in the United States.
• In 2006, approximately 76% of stents implanted during PCI were drug-eluting, compared with 24 percent bare-metal stents.
• In 2006, there were 652,000 PCI procedures with stents — 425,000 in men, 227,000 in women.

If you recently had cardiac stenting and require another surgery, make sure to ask your doctor about waiting to have the next surgery. This is particularly true if your next surgery is an elective one. If your doctor or surgeon is not a cardiologist, you may want to consider asking your doctor for a referral to a cardiologist.  You may also want to make sure that your physician or surgeon obtains cardiac clearance before proceeding with another surgery.   Don’t assume that your doctor will do these things for you. Be proactive; ask questions.

For related blogs, please see:

• Drug- Eluting Stents Found Effective at Preventing Major Amputations
• Angina: The Efficacy of Percutaneous Coronary Intervention v. the Efficacy of Non-Surgical Treatment.
• The Efficacy of Drug-Eluting Stents and Bare Metal Stents in Heart Transplant Recipients with Coronary Artery Disease
• Study Finds Stents as Effective as Surgery to Prevent Strokes; European Study Finds Otherwise
• St. Joseph Medical Center Stent Patients Now Face Another Risk: The FDA Requires a Black-Box Warning on Anti-Clotting Drug Plavix
• St. Joseph Tells 169 More Patients They May Have Had Unneeded Surgery; Total Notified Now at 538
• Bill Clinton’s Stent Procedure – What It’s All About

Contributing author: Jon Stefanuca

Drug-Eluting Stents Found Effective at Preventing Major Amputations

It is generally accepted in the medical community that drug-eluting stents (DES) are helpful in restoring normal blood flow to the heart. In recent years, however, DES treatment has been applied with proven success in other contexts.

For example, consider a patient with peripheral vascular disease (PVD); an unfortunately common medical condition characterized by the occlusion of the arteries of the legs and arms. This disease is usually caused or exacerbated by other medical conditions such as diabetes, high cholesterol, high blood pressure, and kidney disease. People who smoke are at a much higher risk for developing PVD as well. It has been reported that as many as five million adults in the U.S. have PVD.

Patients with PVD tend to experience a gradual decrease in blood flow to their extremities. Over time, this can result in a complete interruption of blood and the development of necrotic tissue. In the past, once necrotic tissue was present, amputation was often the only available medical treatment.

Recent research suggests that DES treatment may be used effectively to prevent or reverse arterial occlusions in patients with PVD. According to an article published by Modern Medicine, researchers studied 106 patients who were treated with DES to restore blood flow in the lower extremities.

There were no procedural deaths, and 96 percent of the patients were discharged within 24 hours. The researchers found that the three-year cumulative incidence of amputation was 6 percent ± 2 percent, survival was 71 percent ± 5 percent, and amputation-free-survival was 68 percent ± 5 percent. Also, only 12 percent of patients who died had a previous major amputation. The target limb revascularization rate was 15 percent.

This study suggests that DES treatment can be effective at preventing major amputations. If you are facing the possibility of amputation as a result of PVD or another ischemic process, ask your doctor about angioplasty and DES treatment.

Contributing author: Jon Stefanuca