Post-PCI management with DES for minor and major non-cardiac surgery

Kim, Jung Sun

Abstract

In-stent restenosis has been reduced significantly after introduction of drug eluting stent (DES). But concern of long-term safety has emerged because of inappropriate neointimal coverage over stent related with cytotoxic drug and polymer. Recently, non-cardiac surgery after DES implantation is increasing and use of anti-platelet agent during operation might be problematic. Non-cardiac surgery might increase the risk of stent thrombosis, which was related with myocardial infarction and death, particularly in DES. Preoperative discontinuation of dual-antiplatelet therapy (DAT) and early surgery after stent implantation have been well known factors of perioperative stent thrmbosis. Thus, current guideline for anti-platelet therapy in non-cardiac surgery was established in patients after balloon angioplasty and bare metal stent based on duration of DAT according to the period of complete endothelization and neointimal growth after stent implantation. But, there are controversies and little evidence in DES for timing and use of DAT to reduce the stent thrombosis in non-cardiac surgery. Therefore, I reviewed the existing data about stent thrombosis after noncardiac surgery, the impact of delay from surgery and discontinuation of DAT. Based on these published data, I suggested recommendations for patients who require noncardiac surgery after DES.