Abstract 18208: Prospective and Systematic Analysis of Unexpected Requests for Non-cardiac Surgery or Invasive Procedures During the First Year after Drug-eluting Stents Implantation
Background: No sufficient data exists regarding prevalence, timing and clinical outcomes of unexpected requests for non-cardiac surgery or invasive procedures during the first year after drug-eluting stents (DESs) implantation
Methods and Results: We randomly assigned 2,117 patients with coronary artery stenosis into two groups according to dual antiplatelet therapy (DAPT) duration and stent type; 3-month DAPT following Endeavor zotarolimus-eluting stent (E-ZES) implantation (E-ZES+3-month DAPT, n=1,059) vs. 12-month DAPT following the other DES implantation (standard therapy, n=1,058). We prospectively investigated the prevalence, timing and clinical outcomes of unexpected requests for non-cardiac surgery or invasive procedures during the first year after DESs implantation between the two groups. The prevalence of requested non-cardiac surgery or invasive procedures was 14.6% (310 requests 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. The rates of actual discontinuation of DAPT, and non-cardiac surgery or invasive procedure finally performed were 35.8% and 52.6%, respectively. On per-request level analysis, the rate of actual discontinuation of DAPT and the rate of non-cardiac surgery or invasive procedure finally performed were significantly different between E-ZES+3-month DAPT vs. standard therapy (See figure). There were no patients with death or stent thrombosis related with actual discontinuation of DAPT.
Conclusions: The requests for unexpected non-cardiac surgery or invasive procedure with premature discontinuation of DAPT are relatively common. Compared to standard therapy, E-ZES+3-month DAPT may give more confidence to the physicians for expected patients requiring early discontinuation DAPT after DES implantation.
- © 2012 by American Heart Association, Inc.