在冠状动脉支架插入后选择性重大非心脏手术的风险:基于人口的研究
Duminda N Wijeysundera1, Harindra C Wijeysundera, Lingsong Yun
1Li Ka Shing Knowledge Institute of St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. d.wijeysundera@utoronto.ca
Circulation
|August 16, 2012
概括
选择性手术应在裸金属支架植入后延迟46-180天,在药物释放支架植入后延迟180天,以尽量减少心脏事件.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
背景情况:
- 目前的指导方针建议将非心脏手术推迟到裸金属支架 (BMS) 后30-45天和药物排泄支架 (DES) 后1年.
- 在冠状动脉支架植入后进行非心脏手术的最佳时间仍然是一个关键的临床问题.
研究的目的:
- 确定冠状动脉支架植入后进行重大选择性非心脏手术的最佳时间.
- 评估手术时间和主要心脏不良事件 (MACE) 之间的关联.
主要方法:
- 一项对8116名患者 (≥40岁) 的队列研究,在冠状动脉支架植入后,在加拿大安大略省 (2003-2009) 接受了重大选择性非心脏手术.
- 链接的注册表和行政医疗保健数据被用来跟踪30天的MACE (死亡率,急性冠状动脉综合征,重复血管化).
- 包括341,350名没有先前冠状动脉再血管化的手术患者的比较队列.
主要成果:
- 冠状动脉支架患者的整体30天MACE率为2.1%.
- 当手术发生在支架后45天以下时,事件发生率最高 (BMS:6.7%,DES:20.0%).
- 对于BMS,事件发生率在45-180天后降至2.6%,并在180天后接近非再血管化的个体的发生率.
- 对于DES来说,180天后事件发生率为1.2%,与非再血管集团相似.
结论:
- 选择性手术的最早最佳间隔是在BMS植入后的46至180天.
- 对于DES,手术应该推迟180天以上,以达到类似的安全性.
- 这些发现完善了当前对冠状动脉支架患者外科手术期间管理的建议.
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