Post-MI Surgery Timing — FRCA Final MCQ

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ModeratePreoperative AssessmentPost-MI Surgery TimingFRCA Final

A 70-year-old man had an anterior ST-elevation myocardial infarction treated by percutaneous coronary intervention with insertion of a bare-metal coronary stent. He has no excessive bleeding risk. He subsequently requires elective non-cardiac surgery that will necessitate interruption of his P2Y12 inhibitor. To permit completion of the standard UK-recommended course of dual antiplatelet therapy after myocardial infarction, what interval should normally elapse between the infarction and surgery?

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Correct answer: D — 12 months

The correct answer is D. NICE recommends dual antiplatelet therapy for up to 12 months after myocardial infarction unless contraindicated. Following PCI for an acute coronary syndrome, this recommendation is determined principally by the acute coronary presentation rather than by whether the implanted stent is bare-metal or drug-eluting. Elective surgery requiring interruption of the P2Y12 inhibitor should therefore normally await completion of this course. Four weeks is the traditional minimum DAPT period after bare-metal stenting for stable coronary disease and is not the standard duration after an MI. Three or six months may be considered when surgery is time-sensitive or bleeding risk justifies abbreviated therapy, but those qualifications are excluded by the stem. Two weeks is too early because of the particularly high risk of stent thrombosis and recurrent ischaemia.

Reference: National Institute for Health and Care Excellence. Acute coronary syndromes, NG185, recommendation 1.4.15, 2020; last reviewed 27 March 2026. https://www.nice.org.uk/guidance/NG185/chapter/recommendations