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Prospective and Systematic Analysis of Unexpected Requests for Non-Cardiac Surgery or Other Invasive Procedures during the First Year after Drug-Eluting Stent Implantation.

Authors
 Byeong-Keuk Kim  ;  Jung-Han Yoon  ;  Dong-Ho Shin  ;  Jung-Sun Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Seung-Hwan Lee  ;  Gary S. Mintz  ;  Yangsoo Jang  ;  Myeong-Ki Hong 
Citation
 YONSEI MEDICAL JOURNAL, Vol.55(2) : 345-352, 2014 
Journal Title
 YONSEI MEDICAL JOURNAL 
ISSN
 0513-5796 
Issue Date
2014
MeSH
Aged ; Attitude to Health ; Coronary Artery Disease/drug therapy ; Drug-Eluting Stents* ; Female ; Follow-Up Studies ; Health Behavior* ; Humans ; Male ; Middle Aged ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors/therapeutic use ; Regression Analysis ; Sirolimus/administration & dosage ; Sirolimus/analogs & derivatives ; Sirolimus/therapeutic use ; Surgical Procedures, Operative* ; Treatment Outcome ; Treatment Refusal/statistics & numerical data
Keywords
Antiplatelet therapy ; coronary artery disease ; drug-eluting stents
Abstract
PURPOSE: Unexpected requests for non-cardiac surgery requiring discontinuation of dual antiplatelet therapy (DAPT) frequently occur in daily clinical practice. The objectives of this study were to evaluate prevalence, timing and clinical outcomes of such unexpected requests for non-cardiac surgery or other invasive procedures during the first year after drug-eluting stents (DESs) implantation. MATERIALS AND METHODS: We prospectively investigated the prevalence, timing and clinical outcomes of unexpected requests for non-cardiac surgery or other procedures during the first year after DESs implantation in 2117 patients. RESULTS: The prevalence of requested non-cardiac surgery or invasive procedures was 14.6% in 310 requests and 12.3% in 261 patients. Among 310 requests, those were proposed in 11.3%<1 month, 30.0% between 1 and 3 months, 36.8% between 4 and 6 months and 21.9% between 7 and 12 months post-DES implantation. The rates of actual discontinuation of DAPT and non-cardiac surgery or procedure finally performed were 35.8% (111 of 310 requests) and 53.2% (165 of 310 requests), respectively. On multivariate regression analysis, the most significant determinants for actual discontinuation of DAPT were Endeavor zotarolimus-eluting stent implantation with 3-month DAPT (OR=5.54, 95% CI 2.95-10.44, p<0.001) and timing of request (OR=2.84, 95% CI 1.97-4.11, p<0.001). There were no patients with any death, myocardial infarction, or stent thrombosis related with actual discontinuation of DAPT. CONCLUSION: Those unexpected requests with premature discontinuation of DAPT were relatively common and continuously proposed during the first year following DES implantation. No death, myocardial infarction or stent thrombosis occurred in patients with actual discontinuation of DAPT.
Files in This Item:
T201400347.pdf Download
DOI
10.3349/ymj.2014.55.2.345
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 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
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
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
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98147
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