Dual anti-platelet therapy after coronary drug-eluting stent implantation and surgery-associated major adverse events.
Surgery may necessitate interruption of dual antiplatelet therapy (DAPT) within the first year after coronary drug-eluting stent (DES) implantation. We conducted a population-based cohort study to assess the rate of surgery within the first year after DES implantation, surgery-associated major adverse cardiac events (MACE), reoperation for bleeding within 30 days after surgery, and two nested case-control analyses to explore any association between preoperative antiplatelet therapy, MACE, and reoperation for bleeding. In the cohort of 22,654 patients treated with DES, 1,944 patients (8.6 %) underwent moderate- to high-risk surgery within 12 months. Of these, 62 (3.2 %) experienced MACE and 54 (2.8 %) needed reoperation for bleeding within 30 days. In the nested case-control analyses of 458 cases and controls, where 70 % (n=324) had a first generation DES, absence of preoperative antiplatelet therapy was associated with an increased MACE rate (OR 2.36, 95 % CI 1.02-5.48) compared to single antiplatelet therapy (SAPT) or DAPT. Preoperative SAPT versus DAPT showed no difference in MACE rates (OR 0.85, 95 % CI 0.30-2.40). Surgery within the first month was associated with increased MACE rate (OR 4.67, 95 % CI 2.22-9.83) compared to surgery 2-12 months after DES implantation. Absence of preoperative antiplatelet therapy did not reduce reoperation for bleeding as compared to patients on SAPT or DAPT (OR 1.32, 95 % CI 0.56-3.12). In conclusion, absence of preoperative antiplatelet therapy and surgery within the first month after DES implantation were associated with increased MACE rates.
Dr. Gro Egholm, Aarhus University Hospital, Department of Cardiology, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark, Tel.: +45 60 62 42 84, E-mail: grochi@rm.dk.
Gro
G
Egholm
Troels
T
Thim
Kevin Kris
KK
Olesen
Morten
M
Madsen
Henrik Toft
HT
Sorensen
Svend Eggert
SE
Jensen
Lisette Okkels
LO
Jensen
Hans Erik
HE
Botker
Steen Dalby
SD
Kristensen
Michael
M
Maeng
D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D002318:Cardiovascular Diseases / Q000209:etiology; D016022:Case-Control Studies; D015331:Cohort Studies; D054855:Drug-Eluting Stents / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D012086:Reoperation
D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D001241:Aspirin
Antiplatelet agents; epidemiological studies; ischaemic heart disease; surgery