Treatment Algorithm for Timing of Elective Noncardiac Surgery in Patients with Coronary Stents.

Treatment Algorithm for Timing of Elective Noncardiac Surgery in Patients with Coronary Stents. A.5. What are the risk factors for perioperative myocardial infarction (MI) in patients with ischemic heart disease? What can be done to reduce the risk of ischemic events in these patients? A.5. What are the risk factors for perioperative myocardial infarction (MI) in patients with ischemic heart disease? What can be done to reduce the risk of ischemic events in these patients?

«Flowchart»

Patients Treated With PCI Undergoing Elective Noncardiac Surgery

BMS treated with DAPT

DES treated with DAPT

End

0 d

30 d

<30 d since BMS implantation

30 d

<30 d since BMS implantation

<30 d

≥30 d since BMS implantation

≥ >=30 d

Class I:
Proceed with surgery

Class I:

Class III: Harm
Delay surgery

Class III:

30 d

<3 mo since DES implantation

30 d

<3 mo since DES implantation

<3 mo

3 mo

3-6 mo since DES implantation, discontinue DAPT; delayed surgery risk is great than stent thrombosis risk

3 mo

3-6 mo since DES implantation, discontinue DAPT; delayed surgery risk is great than stent thrombosis risk

3-6 mo

6 mo

≥6 mo since DES implantation, discontinue DAPT

6 mo

≥6 mo since DES implantation, discontinue DAPT

≥ >=6 mo

Class I:
Proceed with surgery

Class I:

3 mo

Class III: Harm
Delay surgery

3 mo

Class III: Harm
Delay surgery

3 mo

Class III: Harm
Delay surgery

Class III:

6 mo

Class IIb:
Proceeding with surgery may be considered

6 mo

Class IIb:
Proceeding with surgery may be considered

6 mo

Class IIb:
Proceeding with surgery may be considered

Class IIb:

BMS, bare metal stent; DAPT, dual antiplatelet therapy; DES, drug-eluting stent; PCI, percutaneous coronary intervention.