title: Antiplatelet therapy and outcome in patients undergoing surgery following coronary stenting: Results of the surgery after stenting registry.
abstract: OBJECTIVE
  The aim of the present study was to define the feasibility and clinical impact of complying with national consensus recommendations on perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery.
  
  
  BACKGROUND
  There are limited evidence-based recommendations on the perioperative management of antiplatelet therapy in stented patients undergoing surgery.
  
  
  METHODS
  The recommendations provided by the national consensus document were applied in a multicenter, prospective registry of consecutive patients with prior coronary stenting undergoing any type of surgery at 19 hospitals in Italy. The primary end-point was in-hospital net adverse clinical events (NACE) represented by the composite of all-cause death, myocardial infarction, probable/definite stent thrombosis and Bleeding Academic Research Consortium (BARC) grade ≥3 bleeding. Patients were followed for 30 days.
  
  
  RESULTS
  A total of 1,082 patients were enrolled. Adherence to consensus recommendations occurred in 85% of the cases. Perioperative aspirin and dual antiplatelet therapy were maintained in 69.7 and 10.5% of the cases, respectively. In-hospital NACE rate was 12.7%, being significantly higher in patients undergoing cardiac surgery (36.3% vs. 7.3%, P < 0.01), mainly due to BARC 3 bleeding events (32.3%). At 30 days, MACE rates were similar (3.5% vs. 3.5%, P = NS) in patients undergoing cardiac and noncardiac surgery, whereas BARC ≥3 bleeding events were significantly higher with cardiac surgery (36.3% vs. 5.6%, P < 0.01).
  
  
  CONCLUSIONS
  The results of this registry demonstrate the safety and feasibility of applying a national consensus document on the perioperative management of antiplatelet therapy in stented patients undergoing surgery. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.affiliation: College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida; Division of Cardiology, University of Florida College of Medicine-Jacksonville; Jacksonville, FL-USA.
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.affiliation: Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Musumeci
authors.affiliation: Dipartimento Di Cardiologia, Ospedale Ferrarotto, Università Di Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: U.O.C. Cardiologia Clinica I, Istituto Clinico Humanitas, Rozzano, (MI), Italy; Dipartimento Cardiovascolare, Humanitas Research Hospital, Rozzano, Milano, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Lettino
authors.affiliation: Dipartimento Di Scienze Cardiovascolari, Centro Cardiologico Monzino, IRCCS, Università Degli Studi Di Milano, Milano, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Trabattoni
authors.affiliation: SSD Centro di valutazione e consulenza cardiologica, Azienda Ospedaliera Brotzu, Presidio San Michele, Cagliari, Italy.
authors.forename: Annarita
authors.initials: A
authors.lastname: Pilleri
authors.affiliation: UO Emodinamica, Ospedale Misericordia, Grosseto, USL Toscana Sudest, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabria
authors.affiliation: Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Colombo
authors.affiliation: Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genova, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Bernabò
authors.affiliation: SC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ferlini
authors.affiliation: S.C. Di Cardiologia, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Ferri
authors.affiliation: Dipartimento Di Scienze Cardiache, Toraciche E Vascolari, Università Di Padova, Italia.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: SC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.affiliation: Dipartimento Cardiovascolare, Ospedale A. Manzoni, Lecco, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000592:standards; D032921:Consensus; D003328:Coronary Thrombosis / Q000209:etiology; D004359:Drug Therapy, Combination; D005240:Feasibility Studies; D005260:Female; D019983:Guideline Adherence; D006470:Hemorrhage / Q000139:chemically induced; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality / Q000592:standards; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: antiplatelet therapy; bleeding; ischemia; stent; surgery