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Published on: February 18, 2020
A new approach to percutaneous coronary revascularization in patients requiring undeferrable non-cardiac surgery
Federico Piscione1, Salvatore Cassese, Gennaro Galasso
1Department of Clinical Medicine, Cardiovascular Science and Immunology, Federico II University, Naples, Italy. piscione@unina.it
Insights
Endothelial-progenitor cell-capture stents may allow safe early non-cardiac surgery after coronary stenting by enabling short dual antiplatelet therapy discontinuation. This pilot study found no cardiac events in patients undergoing surgery after stenting.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Surgical Oncology
Background:
- The optimal management strategy for patients requiring coronary revascularization prior to non-cardiac surgery remains unclear.
- This pilot study investigated early major non-cardiac surgery following coronary stenting using a novel endothelial-progenitor cell-capture stent.
Purpose of the Study:
- To evaluate the safety and feasibility of early non-cardiac surgery after coronary stenting with endothelial-progenitor cell-capture stents.
- To assess the impact of short-term dual antiplatelet therapy discontinuation on perioperative cardiac events.
Main Methods:
- Thirty patients underwent coronary angioplasty with endothelial-progenitor cell-capture stent placement before scheduled non-cardiac surgery.
- Dual antiplatelet therapy was discontinued for an average of 12.2 days before surgery.
- Surgery was performed at an average of 17.2 days post-stenting.
Main Results:
- All patients achieved optimal acute procedural results from stenting.
- No perioperative cardiac events were observed in any patient.
- Zero cardiac events occurred at 30-day follow-up after surgery.
Conclusions:
- Preliminary findings suggest endothelial-progenitor cell-capture stents may facilitate early surgery in patients needing coronary stenting.
- Larger studies are warranted to confirm the clinical significance of these findings.
Background:
Optimal strategy for patients who need coronary revascularization before undeferrable non-cardiac surgery is still unknown. We performed a pilot study of dual antiplatelet therapy discontinuation followed by major non-cardiac surgery and endovascular aortic repair early after successful endothelial-progenitor cell-capture coronary stent deployment.
Methods And Results:
Thirty consecutive patients underwent coronary angioplasty plus stenting, before upcoming endovascular or surgical procedures requiring early interruption of antiplatelet therapy. An optimal acute procedural result was observed in all patients. Antiplatelet therapy was stopped before surgery in all patients, achieving an average antiplatelet therapy time of 12.2 ± 3.9 days. Surgery was performed after antiplatelet therapy interruption at an average time interval from revascularization of 17.2 ± 3.9 days. No patient suffered cardiac events during the perioperative period. At thirty day follow-up after surgery there were no cardiac events in all patients.
Conclusions:
Our preliminary data might suggest a role for EPC-capture stent in patients requiring surgical procedures early after coronary stent placement. Further studies on larger population are needed to confirm the clinical impact of our findings.
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