Author + information
- Sandeep Singla, MD,
- Rajesh Sachdeva, MD and
- Barry F. Uretsky, MD⁎ ()
- ↵⁎University of Arkansas for Medical Sciences, Central Arkansas Veterans Healthcare System, 4300 West Seventh Street, Little Rock, Arkansas 72205
We thank Dr. Morice and colleagues for sharing their data regarding reasons for implanting a bare metal stent (BMS) in preference to a drug-eluting stent (DES). In their series, a BMS was chosen because of the need for noncardiac surgery (NCS) within the next year in 5.5% of patients, an incidence similar to that reported in previous studies (1).
We completely agree with the authors that a sizable percentage of BMSs are implanted to avoid the risks associated with long-term dual antiplatelet therapy (DAPT). We also agree with the authors' ideal DES, which would require only a limited period of DAPT after implantation. It is important to emphasize, as we noted in our paper (1), that the actual major adverse cardiac event risk after NCS, a well-known prothrombotic stimulus, remains uncertain, both during the highest risk period (0 to 6 weeks after stent implantation) and thereafter. Further, the value of DAPT to prevent ischemic events during NCS, in the traditional high-risk period and beyond, also is uncertain, as is the relative increased bleeding risk from DAPT continuation. As there is a large cohort of stent patients undergoing NCS, determining the benefit–risk ratio of maintaining DAPT during NCS in a scientifically rigorous study is a laudable goal.
- American College of Cardiology Foundation