Noncardiac surgery following percutaneous coronary intervention

摘要

Percutaneous coronary intervention with implantation of a stent has become the most widely accepted coronary revascularization procedure. It effectively relieves ischemic symptoms, as well as improves survival in a selected group of high-risk patients. Yet, dilemmas arise when patients have to undergo noncardiac surgery after stent implantation. On the one hand, premature discontinuation of antiplatelet therapy has been found to be an important predictor of stent thrombosis. On the other hand, continuation of antiplatelet therapy might increase the risk of bleeding complications during the perioperative period. The issue is further complicated by the impact of timing of the noncardiac surgery on clinical outcomes. This article reviews the perioperative management of patients with coronary stent implantation, with special emphasis on the optimal timing of noncardiac surgery and perioperative use of antiplatelet therapy. Optimization of surgical risk by various pharmacological and nonpharmacological measures before noncardiac surgery are also discussed.