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We appreciate the supportive data provided by Van Norman and Posner regarding an enhanced risk in these patients with coronary artery disease who underwent percutaneous transluminal coronary angioplasty (PTCA) prior to noncardiac surgery (NCS). In contrast to the study cited in their letter (1), our study (2) covered a later time period (1996 to 1998) and included only patients who had undergone coronary stent implantation within six weeks of NCS. Although our conclusions are similar, that there is a paradoxical increase in risk, we found this risk to be demonstrated only in those patients whose NCS occurred within two weeks of stent implantation.
Hence, their suggestion that NCS be postponed 40 to 90 days after coronary intervention may not be applicable to stented patients.
- American College of Cardiology