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Adverse cardiac events in patients with coronary stents undergoing noncardiac surgery: a systematic review.

Hollis RH, Graham LA, Richman JS, Deierhoi RJ, Hawn MT. Adverse cardiac events in patients with coronary stents undergoing noncardiac surgery: a systematic review. American journal of surgery. 2012 Oct 1; 204(4):494-501.

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BACKGROUND: When patients with drug-eluting stents (DES) present for surgery, current guidelines recommend delaying elective surgeries until 1 year of dual antiplatelet therapy has been completed. METHODS: We performed a systematic literature review of the major adverse cardiac events (MACE) associated with noncardiac surgery in patients with DES. RESULTS: Twenty-eight of 358 studies met inclusion criteria. Overall, MACE rates decreased as time to surgery increased and varied from 0% to 18% for surgeries within 1 year as compared with 0% to 12% for surgery more than 1 year after a stent. In addition, the current literature showed limited evidence for a protective effect of continuing perioperative dual antiplatelet therapy on MACE rates. CONCLUSIONS: The current literature supports a significant decrease in MACE when surgery is performed 1 year after DES placement; however, the level of evidence is weak. Larger studies are needed to determine the safe interval for surgery after stent placement.

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