This topic last addressed in the ACC 2014 guideline.
ACC presents data on the rates of reinfarction postoperatively for
patients with an MI before noncardiac surgery. The reinfarction rate is
quite high when surgery occurs within the first 30 days after MI, and
that rate steadily falls as one’s surgery is weeks and months farther
out from an MI. Thus ACC suggests that it would be advisable to delay surgery at least 60 days after an MI.
This topic was last addressed in the ACC 2014 preop guideline and the 2021 revascularization guideline.
The ACC guideline reviews evidence on whether CABG prior to another
planned surgery confers any benefits for subsequent non-cardiac surgery and in which potential sub-types. However, no guideline specifically addresses optimal recovery time after CABG before another non-emergent surgery.
- elective non-cardiac surgery should be delayed 30 days from bare metal stent (BMS) placement (ACC I, B) -
elective non-cardiac surgery performed within 30 days after BMS in patients in whom dual anti-platelet therapy (DAPT) will need to be discontinued perioperatively is potentially harmful due to high risk of stent thrombosis (ACC 3:H, B) - for patients who must undergo a time-sensitive surgery within 30 days of BMS, DAPE should be continued if surgically permissible (ACC text) - intravenous antiplatelet agent perioperative bridging is a new option which may be considered when surgery for those with BMS < 30 days ago cannot be deferred (2b, B)
Angioplasty + DES
Angioplasty with drug eluting stent now has recommendations from ACC divided by indication for percutaneous intervention (PCI) and drug eluting stent (DES).
PCI-DES for ASC (acute coronary ischemia): -delay surgery for ≥ 12 mos when surgery would require interruption of antiplatelet therapy (1) -delay surgery for ≥ 3 mos for time-sensitive surgery (2b) -do not perform surgery ≤ 1 month after PCI-DES (3:H)
PCI-DES for chronic coronary disease: -delay surgery for ≥ 6 mos when surgery would require interruption of antiplatelet therapy (2a) -delay surgery for ≥ 3 mos for time-sensitive surgery (2b) -do not perform surgery ≤ 1 month after PCI-DES (3:H)
In general: -intravenous antiplatelet agent perioperative bridging is a new option which may be considered when surgery for those with PCI-DES < 6 months ago cannot be deferred (2b, B)
- elective surgery should be delayed at least 3 months from the time of incident stroke or TIA to reduce risk of MACE and recurrent stroke (AAC 2a, B)
Much of this guidance is intertwined with recommendations on important antiplatelet medications after these events and interventions to balance both proper recovery form these events, proper use of antiplatelet agents to minimize further ischemic events and post-event complications (like early stent thrombosis), and risks of antiplatelet agents during surgical interventions. The majority of these topics are covered in the ACC 2024 guideline in the section on perioperative antiplatelet therapy mgmt.
