title: Effectiveness of platelet inhibition on major adverse cardiac events in non-cardiac surgery after percutaneous coronary intervention: a prospective cohort study.
abstract: BACKGROUND
  Platelet inhibition is mandatory therapy after percutaneous coronary intervention (PCI). Withdrawal of oral antiplatelet agents has been linked to increased incidence of postoperative adverse cardiac events in post-PCI patients having non-cardiac surgery (NCS). There is limited knowledge of temporal changes in platelet inhibition in this high-risk surgical population. We therefore performed a multicentre prospective cohort study evaluating perioperative platelet function and its association with postoperative major adverse cardiac events (MACE).
  
  
  METHODS
  In 201 post-PCI patients having NCS, we assessed the association between platelet function and postoperative MACE. We performed perioperative platelet function testing using a platelet mapping assay (PMA). Troponin-I was measured every 8 h for 2 days, then daily until day 5. Myocardial infarction was assessed using the third universal definition. We used multivariable logistic regression to assess the association between platelet inhibition and MACE.
  
  
  RESULTS
  Major adverse cardiac events occurred in 40 patients within 30 days of surgery. Thirty-two of these events were non-ST-elevation myocardial infarction, four ST-elevation myocardial infarction, and four exacerbation of congestive heart failure. We were unable to show an association between platelet inhibition and MACE. The PMA showed declining levels of platelet inhibition the longer the antiplatelet therapy was withheld before surgery. Logistic regression did not show an association between preoperative platelet function or the type of stent and MACE. We found an increased cardiac risk of MACE after surgery within 6 weeks of PCI.
  
  
  CONCLUSIONS
  The incidence of MACE in patients undergoing NCS after previous PCI is high in spite of adequate perioperative antiplatelet therapy.
  
  
  BACKGROUND
  NCT 01707459 (registered at http://www.clinicaltrials.gov).
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 The Peter Munk Cardiac Centre, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Department of Anesthesia, University of Toronto, 12 Floor, 123 Edward Street, Toronto, ON Canada M5G 1E2.
authors.forename: M
authors.initials: M
authors.lastname: Wąsowicz
authors.affiliation: Department of Anesthesia Hamilton Health Sciences Corporation, McMaster University, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2.
authors.forename: S
authors.initials: S
authors.lastname: Syed
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Department of Anesthesia, University of Toronto, 12 Floor, 123 Edward Street, Toronto, ON Canada M5G 1E2 Li Ka Shing Knowledge Institute of St Michael's Hospital, 209 Victoria Street, Toronto, ON, Canada M5B 1T8 Institute of Health Policy Management and Evaluation, 155 College Street, Toronto, ON, Canada M5T 3M6.
authors.forename: D N
authors.initials: DN
authors.lastname: Wijeysundera
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: Ł
authors.initials: Ł
authors.lastname: Starzyk
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: D
authors.initials: D
authors.lastname: Grewal
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: T
authors.initials: T
authors.lastname: Ragoonanan
authors.affiliation: Department of Anesthesia Hamilton Health Sciences Corporation, McMaster University, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2.
authors.forename: P
authors.initials: P
authors.lastname: Harsha
authors.affiliation: Department of Anesthesia Hamilton Health Sciences Corporation, McMaster University, 237 Barton Street East, Hamilton, ON, Canada L8L 2X2.
authors.forename: G
authors.initials: G
authors.lastname: Travis
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4.
authors.forename: J
authors.initials: J
authors.lastname: Carroll
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 The Peter Munk Cardiac Centre, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Department of Anesthesia, University of Toronto, 12 Floor, 123 Edward Street, Toronto, ON Canada M5G 1E2 Institute of Health Policy Management and Evaluation, 155 College Street, Toronto, ON, Canada M5T 3M6.
authors.forename: K
authors.initials: K
authors.lastname: Karkouti
authors.affiliation: Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 The Peter Munk Cardiac Centre, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Department of Anesthesia, University of Toronto, 12 Floor, 123 Edward Street, Toronto, ON Canada M5G 1E2 scott.beattie@uhn.ca.
authors.forename: W S
authors.initials: WS
authors.lastname: Beattie
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000188:drug therapy; D000077144:Clopidogrel; D015331:Cohort Studies; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D010975:Platelet Aggregation Inhibitors; D019210:Troponin I; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: major adverse cardiac events; non-cardiac surgery; percutaneous coronary intervention; platelet inhibition