Non-cardiac surgery in patients with coronary stents: the RECO study

Area of Science:

• Cardiology
• Vascular Surgery
• Clinical Trials

Background:

• Management of oral antiplatelet therapy (OAT) during invasive procedures presents a dilemma, balancing risks of ischemic events against bleeding complications.
• Lack of clear guidelines for OAT management in patients with coronary stents undergoing non-cardiac surgery necessitates further investigation.
• NCT01045850 registration indicates a formally conducted clinical study.

Purpose of the Study:

• To determine the incidence of major adverse cardiac and cerebrovascular events (MACCEs) and bleeding complications in patients with coronary stents undergoing non-cardiac surgery.
• To identify independent predictors associated with MACCEs and bleeding in this patient population.

Main Methods:

• A prospective, multicenter, observational cohort study involving 1134 consecutive patients with coronary stents.
• Co-primary endpoints were the incidence of MACCEs and major bleeding within 30 days post-procedure.
• Analysis focused on identifying independent preoperative correlates for both MACCEs and hemorrhagic complications.

Main Results:

• MACCEs occurred in 10.9% of patients, and hemorrhagic complications in 9.5%.
• Independent predictors for MACCEs included OAT interruption >5 days, low hemoglobin, poor creatinine clearance, and emergency/high-risk surgery.
• Independent factors for bleeding included low hemoglobin, moderate creatinine clearance, short delay from stenting to surgery, and high-risk surgery.

Conclusions:

• Patients with coronary stents undergoing invasive procedures are at significant risk for perioperative myocardial infarction, stent thrombosis, and major bleeding.
• Interruption of oral antiplatelet therapy (OAT) for more than 5 days prior to an invasive procedure is a critical factor contributing to MACCEs.
• Risk stratification based on preoperative factors is crucial for managing these high-risk patients.