title: Incidence and outcome of surgical procedures after coronary bare-metal and drug-eluting stent implantation: a report from the CREDO-Kyoto PCI/CABG registry cohort-2.
abstract: BACKGROUND
  There still remain safety concerns on surgical procedures after coronary drug-eluting stents (DES) implantation, and optimal management of perioperative antiplatelet therapy (APT) has not been yet established.
  
  
  RESULTS
  During 3-year follow-up of 12 207 patients (DES=6802 patients and bare-metal stent [BMS] only=5405 patients) who underwent coronary stent implantation in the CREDO-Kyoto registry cohort-2, surgical procedures were performed in 2398 patients (DES=1295 patients and BMS=1103 patients). Surgical procedures (early surgery in particular) were more frequently performed in the BMS group than in the DES group (4.4% versus 1.9% at 42-day and 23% versus 21% at 3-year, log-rank P=0.0007). Cumulative incidences of death/myocardial infarction (MI)/stent thrombosis (ST) and bleeding at 30 days after surgery were low, without differences between BMS and DES (3.5% versus 2.9%, P=0.4 and 3.2% versus 2.1%, P=0.2, respectively). The adjusted risks of DES use relative to BMS use for death/MI/ST and bleeding were not significant (hazard ratio: 1.63, 95% confidence interval: 0.93 to 2.87, P=0.09 and hazard ratio: 0.6, 95% confidence interval: 0.34 to 1.06, P=0.08, respectively). The risks of perioperative single- and no-APT relative to dual-APT for both death/MI/ST and bleeding were not significant; single-APT as compared with dual-APT tended to be associated with lower risk for death/MI/ST (hazard ratio: 0.4, 95% confidence interval: 0.13 to 1.01, P=0.053).
  
  
  CONCLUSIONS
  Surgical procedures were commonly performed after coronary stent implantation, and the risk of ischemic and bleeding complications in surgical procedures was low. In patients selected to receive DES or BMS, there were no differences in outcomes. Perioperative administration of dual-APT was not associated with lower risk for ischemic events.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Tokushige
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.forename: Masashi
authors.initials: M
authors.lastname: Iwabuchi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Tada
authors.forename: Junichi
authors.initials: J
authors.lastname: Tazaki
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Mamoru
authors.initials: M
authors.lastname: Hayano
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Abe
authors.forename: Natsuhiko
authors.initials: N
authors.lastname: Ehara
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Inada
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaburagi
authors.forename: Shuichi
authors.initials: S
authors.lastname: Hamasaki
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakashima
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Ryozo
authors.initials: R
authors.lastname: Tatami
authors.forename: Satoru
authors.initials: S
authors.lastname: Suwa
authors.forename: Akinori
authors.initials: A
authors.lastname: Takizawa
authors.forename: Ryuji
authors.initials: R
authors.lastname: Nohara
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mitsudo
authors.forename: Masakiyo
authors.initials: M
authors.lastname: Nobuyoshi
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D003331:Coronary Vessels / Q000187:drug effects / Q000473:pathology / Q000601:surgery*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011183:Postoperative Complications; D012042:Registries; D016019:Survival Analysis; D013927:Thrombosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D010975:Platelet Aggregation Inhibitors