Elective surgery in post-percutaneous coronary intervention patients

This approach to the timing of surgery is based on published guidelines and our contributors' expertise. Our suggestions may not be appropriate for all patients. The risks and benefits of P2Y12 interruption for surgery should be weighed for each patient.

ACS: acute coronary syndrome; DAPT: dual antiplatelet therapy; LVEF: left ventricular ejection fraction; PCI: percutaneous coronary intervention.

* Risk factors for stent thrombosis include ACS within 3 months of PCI, history of stent thrombosis, chronic kidney disease, LVEF <40%, diffuse multivessel disease in a patient with diabetes mellitus, and recent complex PCI.

¶ A range is provided due to differences in the European and American guidelines.

References:

Halvorsen S, Mehilli J, Cassese S, et al. 2022 ESC guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery. Eur Heart J 2022; 43:3826.
Thompson A, Fleischmann KE, Smilowitz NR, et al. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM guideline for perioperative cardiovascular management for noncardiac surgery: A report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol 2024; 84:1869.

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Elective surgery in post-percutaneous coronary intervention patients