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Perioperative Antiplatelet Strategy in Patients Undergoing Noncardiac Surgery Within One Year After Percutaneous Coronary Intervention

Authors
 Sang-Hyup Lee  ;  Choongki Kim  ;  Sanghoon Shin  ;  Hyeongsoo Kim  ;  Jong-Kwan Park  ;  Seung-Jin Oh  ;  Sung Gyun Ahn  ;  Sungsoo Cho  ;  Oh-Hyun Lee  ;  Jae Youn Moon  ;  Hoyoun Won  ;  Yongsung Suh  ;  Yun-Hyeong Cho  ;  Jung Rae Cho  ;  Byoung-Kwon Lee  ;  Yong-Joon Lee  ;  Seung-Jun Lee  ;  Sung-Jin Hong  ;  Dong-Ho Shin  ;  Chul-Min Ahn  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang  ;  Jung-Sun Kim 
Citation
 AMERICAN JOURNAL OF MEDICINE, Vol.136(10) : 1026-1034, 2023-10 
Journal Title
AMERICAN JOURNAL OF MEDICINE
ISSN
 0002-9343 
Issue Date
2023-10
MeSH
Drug-Eluting Stents* ; Hemorrhage / chemically induced ; Hemorrhage / drug therapy ; Hemorrhage / prevention & control ; Humans ; Percutaneous Coronary Intervention* / adverse effects ; Platelet Aggregation Inhibitors / therapeutic use ; Treatment Outcome
Keywords
Antiplatelet therapy ; Net adverse clinical events ; Non-cardiac surgery ; Percutaneous coronary intervention
Abstract
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.
Full Text
https://www.sciencedirect.com/science/article/pii/S000293432300390X
DOI
10.1016/j.amjmed.2023.06.003
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Shin, Dong Ho(신동호) ORCID logo https://orcid.org/0000-0002-7874-5542
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
Lee, Byoung Kwon(이병권) ORCID logo https://orcid.org/0000-0001-9259-2776
Lee, Sanghyup(이상협)
Lee, Seung-Jun(이승준) ORCID logo https://orcid.org/0000-0002-9201-4818
Lee, Oh Hyun(이오현) ORCID logo https://orcid.org/0000-0001-7070-7720
Lee, Yong Joon(이용준)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/196717
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