title: Bridge therapy or standard treatment for urgent surgery after coronary stent implantation: Analysis of 314 patients.
abstract: Intravenous administration of a short acting glycoprotein IIb/IIIa inhibitor has been proposed as a bridge to surgery in patients on dual antiplatelet treatment, but data in comparison with other treatment options are not available. We conducted a retrospective analysis of consecutive patients who underwent un-deferrable, non-emergency surgery after coronary stenting. The bridge therapy was performed after discontinuation of the oral P2Y12 inhibitor by using i.v. tirofiban infusion. Net Adverse Clinical Events (NACE) was the primary outcome. We analyzed 314 consecutive patients: the bridge strategy was performed in 87 patients, whereas 227 were treated with other treatment options and represent the control group. Thirty-day NACE occurred in 8% of patients in the bridge group and in 22.5% in the control group (p < 0.01). Bridge therapy was associated with decreased 30-day NACE rate [Odds ratio (OR) 0.30; 95% confidence interval (CI) 0.13-0.39; p < 0.01], particularly when the time interval between stenting and surgery was ≤ 60 days (OR 0.09, 95% CI 0.01-0.72; p = 0.02). There were no cases of stent thrombosis in the bridge group and 3 (1.3%) in the control group. Bridge therapy was associated with decreased events rates as compared to both patients with and without P2Y12 inhibitors discontinuation in the control group. After adjustment for the most relevant covariates, the favorable effect of the bridge therapy was not materially modified. In conclusion, perioperative bridge therapy using tirofiban was associated with reduced 30-day NACE rate, particularly when surgery was performed within 60 days after stent implantation.
authors.affiliation: Coronary Care Unit, IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: s.deservi@smatteo.pv.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.affiliation: Division of Cardiology 1-Interventional Cardiology, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milano, Italy.
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.affiliation: Division of Cardiology, University Hospital, Terni, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Boschetti
authors.affiliation: USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.affiliation: Cardiovascular Department, Civic Hospital, Legnano, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Martina
authors.affiliation: USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: Cardiovascular Department, Civic Hospital, Legnano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: D'Urbano
authors.affiliation: Division of Cardiology, University Hospital, Terni, Italy.
authors.forename: Ludovico
authors.initials: L
authors.lastname: Lazzari
authors.affiliation: Department of Clinical Science and Community Health, University of Milan, Milano, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.affiliation: USC Cardiologia, Dipartimento Cardiovascolare, AO Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Senni
authors.affiliation: Division of Cardiology 1-Interventional Cardiology, Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milano, Italy.
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.affiliation: Division of Cardiology, Azienda Ospedaliera della Provincia di Lecco, Ospedale A. Manzoni, Lecco, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019917:Blood Vessel Prosthesis Implantation; D023921:Coronary Stenosis / Q000601:surgery; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D019106:Postoperative Hemorrhage / Q000378:metabolism / Q000517:prevention & control*; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D000077466:Tirofiban; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D058921:Purinergic P2Y Receptor Antagonists; D014443:Tyrosine; D000077466:Tirofiban; D001241:Aspirin
keywords: ADP receptors; Coronary syndrome; Platelet glycoproteins