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Capacity assessment — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeCapacity assessmentUSMLE Step 3

A 62-year-old had an NSTEMI treated with a drug-eluting coronary stent 4 months ago and takes aspirin plus clopidogrel. Severe hip osteoarthritis limits walking, but arthroplasty is elective and the surgeon requires interruption of clopidogrel. There has been no recurrent ischemia. When should surgery ideally be performed?

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Correct answer: E — Delay arthroplasty until at least 12 months after the acute-coronary-syndrome PCI

The best answer is “Delay arthroplasty until at least 12 months after the acute-coronary-syndrome PCI”. The 2024 AHA/ACC perioperative guideline advises delaying elective noncardiac surgery that requires interruption of at least one antiplatelet agent for at least 12 months after drug-eluting-stent PCI performed for an acute coronary syndrome. The 6-month interval applies to chronic coronary disease, and heparin does not replace P2Y12 inhibition against stent thrombosis.

Reference: 2024 AHA/ACC Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: https://professional.heart.org/en/guidelines-statements/2024-ahaaccacsasnchrsscascctscmrsvm-guideline-for-perioperative-cardiovascularcir0000000000001285