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Eur J Cardiothorac Surg 2006;30:793-796
© 2006 Elsevier Science NL

Perioperative in-stent thrombosis after lung resection performed within 3 months of coronary stenting

^a Department of Thoracic Surgery, Centre Hospitalier Universitaire Grenoble, France
^b Department of Thoracic Surgery, Centre Hospitalier Universitaire Le Havre, France
^c Department of Thoracic Surgery, Centre Hospitalier Universitaire Cedre, France
^d Department of Thoracic Surgery, Centre Hospitalier Universitaire Nice, France
^e Department of Thoracic Surgery, Centre Hospitalier Universitaire Rouen, France
^f Department of Thoracic Surgery, Centre Hospitalier Universitaire Laennec, Paris, France
^g Department of Thoracic Surgery, Centre Hospitalier Universitaire Bordeaux, France
^h Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland

Received 11 May 2006; received in revised form 25 July 2006; accepted 21 August 2006.

^_* Corresponding author. Tel.: +41 21 314 24 08; fax: +41 21 314 2358. (Email: hans-beat.ris{at}chuv.ch).

Background: Incidence of perioperative in-stent thrombosis associated with myocardial infarction in patients undergoing major lung resection within 3 months of coronary stenting. Methods: Retrospective multi-institutional trial including all patients undergoing major lung resection (lobectomy or pneumonectomy) within 3 months of coronary stenting with non-drug-eluting stents between 1999 and 2004. Results: There were 32 patients (29 men and 3 women), with age ranging from 46 to 82 years. One, two or four coronary stents were deployed in 72%, 22% and 6% of the patients, respectively. The time intervals between stenting and lung surgery were <30 days, 30–60 days and 61–90 days in 22%, 53% and 25% of the patients, respectively. All patients had dual antiplatelet therapy after stenting. Perioperative medication consisted of heparin alone or heparin plus aspirin in 34% and 66% of the patients, respectively. Perioperative in-stent thrombosis with myocardial infarction occurred in three patients (9%) with fatal outcome in one (3%). Twenty patients underwent lung resection after 4 weeks of dual antiplatelet therapy as recommended by the ACC/AHA Guideline Update; however, two out of three perioperative in-stent thrombosis occurred in this group of patients. Conclusions: Major lung resection performed within 3 months of coronary stenting may be complicated by perioperative in-stent thrombosis despite 4 weeks of dual antiplatelet therapy after stenting as recommended by the ACC/AHA Guideline Update.

Key Words: Ischemic heart disease • Coronary stenting • Lobectomy • Pneumonectomy • Stent thrombosis

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