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BJA Advance Access published online on March 5, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aeh110
© 2004 by The Board of Management and Trustees of the British Journal of Anaesthesia
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Accepted June 11, 2003

Case Reports

Fatal myocardial infarction after lung resection in a patient with prophylactic preoperative coronary stenting{dagger}

C. Marcucci 1, P.-G. Chassot 1, J.-P. Gardaz 1, L. Magnusson 1, H.-B. Ris 2, A. Delabays 3, D. R. Spahn 1*

1 Department of Anaesthesiology, University Hospital Lausanne (CHUV), 46 Rue Bugnon, CH-1011 Lausanne, Switzerland
2 Department of Surgery, University Hospital Lausanne (CHUV), 46 Rue Bugnon, CH-1011 Lausanne, Switzerland
3 Division of Cardiology, University Hospital Lausanne (CHUV), 46 Rue Bugnon, CH-1011 Lausanne, Switzerland

* To whom correspondence should be addressed. E-mail: donat.spahn{at}chuv.hospvd.ch.


  Abstract

In this report we present the case of a 77-yr-old man who underwent resection of the upper lobe of the left lung for a carcinoma, six weeks after percutaneous transluminal coronary angioplasty (PTCA) with stenting of the left anterior descending (LAD) and circumflex coronary arteries. Antiplatelet therapy with clopidogrel was interrupted two weeks before surgery to allow for epidural catheter placement and to minimize haemorrhage. The surgical procedure was uneventful. In the immediate postoperative period, however, the patient suffered severe myocardial ischaemia. Emergency coronary angiography showed complete thrombotic occlusion of the LAD stent. In spite of successful recanalization, reinfarction occurred and the patient died in cardiogenic shock. Prophylactic preoperative coronary stenting may put the patient at risk of stent thrombosis if surgery cannot be postponed for three months. In such cases, other strategies such as perioperative {beta}-blockade for preoperative cardiac management should be considered.

Keywords: Keywords: complications, coronary artery disease; heart, coronary revascularization; surgery, non-cardiac


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