Effect of Perioperative Antiplatelet Therapy on Outcomes in Patients With Drug-Eluting Stents Undergoing Elective Noncardiac Surgery

Sung Jin Hong, Min Ji Kim, Jung Sun Kim, Eun Hwa Kim, Jinae Lee, Chul Min Ahn, Byeong Keuk Kim, Young Guk Ko, Donghoon Choi, Myeong Ki Hong, Yangsoo Jang

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

We investigated the association of perioperative antiplatelet therapy (APT) and outcomes in patients with drug-eluting stent (DES) placement for noncardiac surgery (NCS). In consecutive 23,358 patients who underwent percutaneous coronary interventions between 2005 and 2016, total of 2,179 patients that required 2,179 elective NCS after DES placement were retrospectively analyzed. A net adverse clinical event (NACE), composite of death, myocardial infarction, stent thrombosis, and major bleeding, was assessed at 30 days. Of 2,179 patients, 937 patients (43%) underwent NCS with discontinuation of APT. For overall, NACE occurred in 10 patients who discontinued APT (1.1%) and 22 patients who continued APT (1.8%) without significant differences (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.28 to 1.27, p = 0.182). Also, adjusted NACE event rates were not different between groups for overall NCSs (adjusted HR 0.76, 95% CI 0.38 to 1.52, p = 0.440), for NCSs >1, ≤12 months after DES, and for NCSs >12 months after DES. Our findings persisted (adjusted HR 1.26, 95% CI 0.51 to 3.10, p = 0.618) when those who continued dual-APT were excluded from the continuation of APT group due to a higher tendency of NACE compared with those who continued single-APT (adjusted HR 2.26, 95% CI 0.98 to 5.21, p = 0.055). However, the patients who discontinued APT for >7 days had a significantly higher NACE than those who discontinued for ≤7 days (adjusted HR 6.93, 95% CI 2.16 to 22.24, p = 0.001). In conclusion, discontinuation of APT may not be associated with higher NACEs 30 days postsurgery compared with continuation of APT, when APT was discontinued for ≤7 days in patients undergoing elective NCS after DES implantation.

Original languageEnglish
Pages (from-to)1414-1421
Number of pages8
JournalAmerican Journal of Cardiology
Volume123
Issue number9
DOIs
Publication statusPublished - 2019 May 1

Fingerprint

Drug-Eluting Stents
Confidence Intervals
Therapeutics
Percutaneous Coronary Intervention
Group Psychotherapy
Stents
Thrombosis
Myocardial Infarction
Hemorrhage

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Hong, Sung Jin ; Kim, Min Ji ; Kim, Jung Sun ; Kim, Eun Hwa ; Lee, Jinae ; Ahn, Chul Min ; Kim, Byeong Keuk ; Ko, Young Guk ; Choi, Donghoon ; Hong, Myeong Ki ; Jang, Yangsoo. / Effect of Perioperative Antiplatelet Therapy on Outcomes in Patients With Drug-Eluting Stents Undergoing Elective Noncardiac Surgery. In: American Journal of Cardiology. 2019 ; Vol. 123, No. 9. pp. 1414-1421.
@article{cf18dab8906840988c841fe882fb825a,
title = "Effect of Perioperative Antiplatelet Therapy on Outcomes in Patients With Drug-Eluting Stents Undergoing Elective Noncardiac Surgery",
abstract = "We investigated the association of perioperative antiplatelet therapy (APT) and outcomes in patients with drug-eluting stent (DES) placement for noncardiac surgery (NCS). In consecutive 23,358 patients who underwent percutaneous coronary interventions between 2005 and 2016, total of 2,179 patients that required 2,179 elective NCS after DES placement were retrospectively analyzed. A net adverse clinical event (NACE), composite of death, myocardial infarction, stent thrombosis, and major bleeding, was assessed at 30 days. Of 2,179 patients, 937 patients (43{\%}) underwent NCS with discontinuation of APT. For overall, NACE occurred in 10 patients who discontinued APT (1.1{\%}) and 22 patients who continued APT (1.8{\%}) without significant differences (hazard ratio [HR] 0.60, 95{\%} confidence interval [CI] 0.28 to 1.27, p = 0.182). Also, adjusted NACE event rates were not different between groups for overall NCSs (adjusted HR 0.76, 95{\%} CI 0.38 to 1.52, p = 0.440), for NCSs >1, ≤12 months after DES, and for NCSs >12 months after DES. Our findings persisted (adjusted HR 1.26, 95{\%} CI 0.51 to 3.10, p = 0.618) when those who continued dual-APT were excluded from the continuation of APT group due to a higher tendency of NACE compared with those who continued single-APT (adjusted HR 2.26, 95{\%} CI 0.98 to 5.21, p = 0.055). However, the patients who discontinued APT for >7 days had a significantly higher NACE than those who discontinued for ≤7 days (adjusted HR 6.93, 95{\%} CI 2.16 to 22.24, p = 0.001). In conclusion, discontinuation of APT may not be associated with higher NACEs 30 days postsurgery compared with continuation of APT, when APT was discontinued for ≤7 days in patients undergoing elective NCS after DES implantation.",
author = "Hong, {Sung Jin} and Kim, {Min Ji} and Kim, {Jung Sun} and Kim, {Eun Hwa} and Jinae Lee and Ahn, {Chul Min} and Kim, {Byeong Keuk} and Ko, {Young Guk} and Donghoon Choi and Hong, {Myeong Ki} and Yangsoo Jang",
year = "2019",
month = "5",
day = "1",
doi = "10.1016/j.amjcard.2019.02.004",
language = "English",
volume = "123",
pages = "1414--1421",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "9",

}

Effect of Perioperative Antiplatelet Therapy on Outcomes in Patients With Drug-Eluting Stents Undergoing Elective Noncardiac Surgery. / Hong, Sung Jin; Kim, Min Ji; Kim, Jung Sun; Kim, Eun Hwa; Lee, Jinae; Ahn, Chul Min; Kim, Byeong Keuk; Ko, Young Guk; Choi, Donghoon; Hong, Myeong Ki; Jang, Yangsoo.

In: American Journal of Cardiology, Vol. 123, No. 9, 01.05.2019, p. 1414-1421.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Effect of Perioperative Antiplatelet Therapy on Outcomes in Patients With Drug-Eluting Stents Undergoing Elective Noncardiac Surgery

AU - Hong, Sung Jin

AU - Kim, Min Ji

AU - Kim, Jung Sun

AU - Kim, Eun Hwa

AU - Lee, Jinae

AU - Ahn, Chul Min

AU - Kim, Byeong Keuk

AU - Ko, Young Guk

AU - Choi, Donghoon

AU - Hong, Myeong Ki

AU - Jang, Yangsoo

PY - 2019/5/1

Y1 - 2019/5/1

N2 - We investigated the association of perioperative antiplatelet therapy (APT) and outcomes in patients with drug-eluting stent (DES) placement for noncardiac surgery (NCS). In consecutive 23,358 patients who underwent percutaneous coronary interventions between 2005 and 2016, total of 2,179 patients that required 2,179 elective NCS after DES placement were retrospectively analyzed. A net adverse clinical event (NACE), composite of death, myocardial infarction, stent thrombosis, and major bleeding, was assessed at 30 days. Of 2,179 patients, 937 patients (43%) underwent NCS with discontinuation of APT. For overall, NACE occurred in 10 patients who discontinued APT (1.1%) and 22 patients who continued APT (1.8%) without significant differences (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.28 to 1.27, p = 0.182). Also, adjusted NACE event rates were not different between groups for overall NCSs (adjusted HR 0.76, 95% CI 0.38 to 1.52, p = 0.440), for NCSs >1, ≤12 months after DES, and for NCSs >12 months after DES. Our findings persisted (adjusted HR 1.26, 95% CI 0.51 to 3.10, p = 0.618) when those who continued dual-APT were excluded from the continuation of APT group due to a higher tendency of NACE compared with those who continued single-APT (adjusted HR 2.26, 95% CI 0.98 to 5.21, p = 0.055). However, the patients who discontinued APT for >7 days had a significantly higher NACE than those who discontinued for ≤7 days (adjusted HR 6.93, 95% CI 2.16 to 22.24, p = 0.001). In conclusion, discontinuation of APT may not be associated with higher NACEs 30 days postsurgery compared with continuation of APT, when APT was discontinued for ≤7 days in patients undergoing elective NCS after DES implantation.

AB - We investigated the association of perioperative antiplatelet therapy (APT) and outcomes in patients with drug-eluting stent (DES) placement for noncardiac surgery (NCS). In consecutive 23,358 patients who underwent percutaneous coronary interventions between 2005 and 2016, total of 2,179 patients that required 2,179 elective NCS after DES placement were retrospectively analyzed. A net adverse clinical event (NACE), composite of death, myocardial infarction, stent thrombosis, and major bleeding, was assessed at 30 days. Of 2,179 patients, 937 patients (43%) underwent NCS with discontinuation of APT. For overall, NACE occurred in 10 patients who discontinued APT (1.1%) and 22 patients who continued APT (1.8%) without significant differences (hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.28 to 1.27, p = 0.182). Also, adjusted NACE event rates were not different between groups for overall NCSs (adjusted HR 0.76, 95% CI 0.38 to 1.52, p = 0.440), for NCSs >1, ≤12 months after DES, and for NCSs >12 months after DES. Our findings persisted (adjusted HR 1.26, 95% CI 0.51 to 3.10, p = 0.618) when those who continued dual-APT were excluded from the continuation of APT group due to a higher tendency of NACE compared with those who continued single-APT (adjusted HR 2.26, 95% CI 0.98 to 5.21, p = 0.055). However, the patients who discontinued APT for >7 days had a significantly higher NACE than those who discontinued for ≤7 days (adjusted HR 6.93, 95% CI 2.16 to 22.24, p = 0.001). In conclusion, discontinuation of APT may not be associated with higher NACEs 30 days postsurgery compared with continuation of APT, when APT was discontinued for ≤7 days in patients undergoing elective NCS after DES implantation.

UR - http://www.scopus.com/inward/record.url?scp=85061340805&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061340805&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2019.02.004

DO - 10.1016/j.amjcard.2019.02.004

M3 - Article

C2 - 30770090

AN - SCOPUS:85061340805

VL - 123

SP - 1414

EP - 1421

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 9

ER -