Harvard Heart Letter

Heart Beat: Stents make later surgery riskier than usual

Undergoing angioplasty and getting a wire-mesh stent to open a narrowed or blocked artery in the heart is easier on the body than bypass surgery. But it still isn't a walk in the park. If life were fair, anyone having this procedure would be spared from the need to have surgery for something else for at least a year. Life, though, isn't fair, and as many as one person in 20 needs noncardiac surgery soon after getting a stent to replace a hip, fix a digestive problem, or correct some other condition. To make matters worse, getting a stent increases the chances of having a heart attack or dying after noncardiac surgery.

Scottish researchers examined the medical records of 18,000 men and women who received a stent. Of those who had noncardiac surgery within six weeks of getting a stent, 42% developed a severe cardiac complication or died, compared with 14% of those who had surgery six to 52 weeks afterward. The type of stent didn't seem to affect the results (Circulation: Cardiovascular Interventions, May 4, 2010).

Surgery fires up inflammation, amplifies the clotting potential of platelets, and reduces the body's natural capacity for busting clots. At the same time, surgeons prefer that their patients temporarily stop taking aspirin and clopidogrel (Plavix), which prevent clots from forming on stents. This combination is a recipe for trouble.

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