In Reply Drs Rassi and Yeh raise an important limitation of our study addressing the risk of noncardiac surgery in patients with recent coronary stent placement. They correctly point out that our study only included patients who successfully underwent surgery. As such, patients scheduled for surgery who had an intervening acute coronary event (potentially due to antiplatelet therapy cessation) would not be included in our cohort.
Therefore, we could be underreporting the actual rate of MACE due to antiplatelet therapy cessation in relation to planned surgery. During our chart review for the study, we identified a single case in which a patient was admitted with an acute coronary event following antiplatelet therapy cessation for surgery and the scheduled surgery was cancelled. The patient subsequently had surgery following stabilization and thus entered our cohort. Nevertheless, our study design did not allow for systematic identification of this clinical scenario.
Hawn MT, Richman JS, Maddox TM. Cardiovascular Event Risk After Noncardiac Surgery—Reply. JAMA. 2014;311(5):525-526. doi:10.1001/jama.2013.285282