Abstract 3433: Noncardiac Surgery after Coronary Stenting; Early Surgery and Interruption of Antiplatelet Therapy are Associated with an Increase in Major Adverse Cardiac Events
Background: Coronary artery stenting (PCI) shortly before non-cardiac surgery is associated with worse postoperative cardiac outcome. Antiplatelet therapy plays a pivotal role in this; interruption may lead to in-stent thrombosis while continuation is associated with excessive blood loss. Also the effect of recently introduced drug eluting stents is ill-defined.
Aim: To assess the influence of drug eluting stents and continuation of antiplatelet therapy on postoperative outcome in non-cardiac surgery.
Methods: All patients who underwent non-cardiac surgery between 1999 and 2005 and had a PCI, either bare metal (n=99) or drug eluting (n=109), because of unstable coronary artery disease within the past two years were enrolled. Cardiac risk factors and medication were noted in all. Importantly, there was no specified protocol for perioperative antiplatelet use in the studied population. The population was divided in an early surgery (<3 months after PCI, n=46) and late surgery (≥ 3 months after PCI, n=162) group. Medical charts were reviewed for the composite endpoint of 30-day nonfatal myocardial infarction and/or cardiac death (MACE).
Results: In total 208 patients (age 63.4 +/- 11.4 years, 151 (73%) males) were included. During the first 30 postoperative days 6 (2.9%) patients experienced a MACE. In the early surgery group 5 (10.9%) MACEs occurred versus 1 (0.6%) in the late surgery group (log rank p<0.001). In particular in patients in the early surgery group the discontinuation of antiplatelet therapy had a detrimental effect, the incidence of MACE was 23.7% in the discontinuation group vs. 0% in patients who continued antiplatelet therapy (log rank p=0.016). Continuation of antiplatelet therapy was not associated with excessive blood loss. There was no difference in MACE between patients with drug eluting stents and those with bare metal stents.
Conclusion: This study showed an adverse outcome after non-cardiac surgery of patients with a recent PCI in whom antiplatelet therapy was discontinued. No difference was observed between bare metal stents and drug eluting stents.