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Perioperative Antiplatelet Strategy in Patients Undergoing Noncardiac Surgery Within One Year After Percutaneous
Sang-Hyup Lee1, Choongki Kim2, Sanghoon Shin2
1Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Insights
Continuing antiplatelet therapy (APT) after percutaneous coronary intervention (PCI) and before non-cardiac surgery may reduce adverse events. This strategy showed lower rates of net adverse clinical events (NACE) and major adverse cardiovascular events (MACE) without increasing bleeding risk.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Optimal antiplatelet therapy (APT) for patients undergoing non-cardiac surgery within one year of percutaneous coronary intervention (PCI) remains unclear.
- Second-generation drug-eluting stents are commonly used, necessitating careful management of perioperative antiplatelet strategies.
- Balancing the risk of stent thrombosis against surgical bleeding complications is a critical clinical challenge.
Purpose of the Study:
- To evaluate the safety and efficacy of continuing APT during non-cardiac surgery in patients with recent PCI.
- To compare the incidence of net adverse clinical events (NACE) and major bleeding between APT continuation and discontinuation strategies.
- To provide evidence-based guidance for managing antiplatelet therapy in this high-risk patient population.
Main Methods:
- A multicenter prospective registry study in Korea included patients undergoing non-cardiac surgery within one year of second-generation drug-eluting stent implantation.
- The primary endpoint was 30-day NACE, encompassing all-cause death, major adverse cardiovascular events (MACE), and major bleeding.
- Propensity score adjustment was used to control for confounding variables between the APT continuation and discontinuation groups.
Main Results:
- Of 1130 eligible patients, 708 (62.7%) continued APT.
- After propensity score adjustment, APT continuation was associated with significantly lower rates of NACE (3.7% vs. 5.5%; adjusted OR, 0.48; P=.019) and MACE (1.1% vs. 1.9%; adjusted OR, 0.35; P=.046).
- The incidence of major bleeding events did not differ significantly between the two strategies (1.7% vs. 2.6%; adjusted OR, 0.61; P=.273).
Conclusions:
- Continuing APT during non-cardiac surgery in patients within one year of second-generation drug-eluting stent implantation was associated with reduced NACE and MACE.
- This strategy did not increase the risk of major bleeding events compared to discontinuing APT.
- The findings suggest a potential benefit of APT continuation in this patient cohort, warranting consideration in clinical practice.
Background:
The optimal antiplatelet therapy (APT) for patients undergoing non-cardiac surgery within 1 year after percutaneous coronary intervention (PCI) is not yet established.
Methods:
Patients who underwent non-cardiac surgery within 1 year after second-generation drug-eluting stent implantation were included from a multicenter prospective registry in Korea. The primary endpoint was 30-day net adverse clinical event (NACE), including all-cause death, major adverse cardiovascular event (MACE), and major bleeding events. Covariate adjustment using propensity score was performed.
Results:
Among 1130 eligible patients, 708 (62.7%) continued APT during non-cardiac surgery. After propensity score adjustment, APT continuation was associated with a lower incidence of NACE (3.7% vs 5.5%; adjusted odds ratio [OR], 0.48; 95% confidence interval [CI], 0.26-0.89; P = .019) and MACE (1.1% vs 1.9%; adjusted OR, 0.35; 95% CI, 0.12-0.99; P = .046), whereas the incidence of major bleeding events was not different between the 2 APT strategies (1.7% vs 2.6%; adjusted OR, 0.61; 95% CI, 0.25-1.50; P = .273).
Conclusions:
The APT continuation strategy was chosen in a substantial proportion of patients and was associated with the benefit of potentially reducing 30-day NACE and MACE with similar incidence of major bleeding events, compared with APT discontinuation. This study suggests a possible benefit of APT continuation in non-cardiac surgery within 1 year of second-generation drug-eluting stent implantation.
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