Background: Elective non-cardiac surgery (NCS) should optimally be delayed one year after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Dual antiplatelet therapy, or at least aspirin is recommended to be continued considering the relative risk of bleeding and stent thrombosis especially during the first 4 to 6 weeks after DES implantation. However, these recommendations are based upon conflicting evidences. 

Methods: Risk factors for postoperative major adverse cardiovascular and cerebral event (MACCE) were investigated. Transfusion requirements and incidence of major bleeding were compared according to cessation of antiplatelet agent.

Results: A total of 962 patients who underwent non-cardiac surgery after DES implantation were reviewed. 52 patients (5.4%) developed postoperative MACCE. Multivariable analysis showed that maintenance of aspirin was associated with lower incidence of MACCE (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI], 0.14-0.84, P=0.020). The frequencies of MACCE were not different according to the different intervals from PCI with DES to NCS after multivariable adjustment. Maintenance of aspirin was associated with increased odds of the incidences of perioperative major bleeding (Adjusted OR 2.83, 95% CI 1.11-7.20, P=0.029).

Conclusions: Maintenance of aspirin was associated with decreased incidence of MACCE after NCS in patients with DES. However, aspirin maintenance was also associated with increased incidence of major bleeding. The incidence of postoperative MACCE was not different according to the time intervals from PCI to surgery. However, firm conclusion cannot be made due to small sample size, retrospective design and inclusion of high proportion of patients with long duration of DES.

Risk of non-cardiac surgery after percutaneous coronary intervention with drug-eluting stents