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Appropriate waiting time for noncardiac surgery following coronary stent insertion: views of Canadian anesthesiologists

Queen’s University, Kingston, Canada, E-mail: ljp{at}post.queensu.ca

To the Editor:

The insertion of a coronary stent is a common procedure for the treatment of patients with cardiovascular disease. Anesthesiologists and cardiac surgeons are often faced with a dilemma about how long to wait between stent insertion and a subsequent surgical procedure. Patients may be placed at risk by either a too short or too long waiting period. The American Heart Association along with the American College of Cardiologists recommend a minimum wait of two weeks and suggest an ideal waiting period of four to six weeks, although these guidelines are not based on randomized controlled trials.¹ It is unclear whether Canadian anesthesiologists are aware of these guidelines. The aim of this survey was to describe the views of practicing anesthesiologists on the waiting times for elective surgery following insertion of a coronary stent.

A postal survey (along with a reminder eight weeks later) was sent to 2,167 Canadian anesthesiologists in March, 2003 seeking their views about the appropriate waiting time for unrelated elective surgery following insertion of a coronary stent. Responders were presented with a clinical scenario (a 59-yr-old male with a prior stent insertion, no comorbidities, who required an urgent aneurysm repair) and asked to report a recommended waiting time for three different locations (left anterior descending, circumflex or right coronary arteries). They were also asked about the existence of a policy on this issue in their departments.

The response rate was 46%. Most departments of anesthesiology (97%) do not have an explicit policy regarding the appropriate waiting time between coronary stent insertion and elective surgery. Half of the responders believed their departments ought to have such a policy. While there was no consensus about what this policy ought to be, the majority of those who wanted a policy felt that the minimum waiting time should be four weeks following surgery (Table). Few anesthesiologists felt that the minimum waiting time should be less than four weeks. A substantial proportion (63%) of Canadian anesthesiologists were unaware of published or unpublished literature, including published U.S. guidelines, about the appropriate length of time between the insertion of a stent and a subsequent surgical procedure.

Acknowledgments

Drs. Ted Ashbury, David Mark, Brian Milne, Joel Parlow, and Chris Simpson for reviewing the questionnaire. The Royal College of Physicians and Surgeons of Canada and the Canadian Anesthesiologists’ Society for providing the mailing list. The anesthesiologists who took the time to complete the questionnaire. The Queen’s University Faculty of Health Sciences Research Initiation Grant for funding this research.

Footnotes

Source of support: Queen’s University Faculty of Health Sciences Research Initiation Grant.

Reference

1 Eagle KA, Berger PB, Calkins H, et al. ACC/AHA Guideline Update for Perioperative Cardiovascular Evaluation for Noncardiac Surgery–Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardac Surgery). Anesth Analg 2002; 94: 1052–64.[Free Full Text]

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