Study: Shorter Buffer OK Between Stenting, Surgery

For patients undergoing percutaneous coronary intervention (PCI) with a drug-eluting stent (DES) and subsequent surgery, waiting a month was a safe enough break between the two procedures, suggested a Danish study.

Patients who went on to get surgery after a DES were more likely to have an MI within 30 days (1.6% versus 0.2% for those without prior PCI, OR 4.82, 95% CI 3.25-7.16). This group was also at an increased risk of cardiac death (1.0% versus 0.2%, OR 5.87, 95% CI 3.60-9.58), although not all-cause mortality (3.1% versus 2.7%, OR 1.12, 95% CI 0.91-1.38).

However, the higher risk of MI or cardiac death was limited to surgery within the first month after stenting, Gro Egholm, MD, PhD, of Aarhus University Hospital in Denmark, and colleagues reported in the Dec. 20 issue of the Journal of the American College of Cardiology.

The data suggested that surgery might be undertaken earlier than the 6 months currently recommended by guidelines, the authors concluded.

Yet that conclusion appeared to contradict recent reports supporting longer waits between PCI and surgery.

Thus, with no randomized data to guide the timing of surgery after PCI, "surgery early after DES-PCI is a gray zone where cardiologists cannot rely solely on science; instead, we must become doctors practicing tailored medicine for individual patients," commented Christian Spaulding, MD, PhD, and Marco G. Mennuni, MD, both of Paris Descartes University, in an accompanying editorial.

Egholm's group linked the Western Denmark Heart Registry with the Danish National Patient Register to get information on patients who had DES implantation followed by surgery within a year (n=4,303). The retrospective study included a group of control patients without a history of ischemic heart disease who underwent the same surgical procedures (n=20,232).

"We are left without a clear answer for the management of dual antiplatelet therapy [DAPT] during surgery as limited information for DAPT administration was gathered in the study," the editorialists noted.

Citing the PARIS registry showing that briefly interrupting DAPT for less than 14 days may still be safe, however, Spaulding and Mennuni concluded that "if surgery cannot be delayed, it can probably be performed safely 1 month after DES-PCI in selected patients."