• Akihiro Tokushige, Hiroki Shiomi, Takeshi Morimoto, Yutaka Furukawa, Yoshihisa Nakagawa, Kazushige Kadota, Masashi Iwabuchi, Satoshi Shizuta, Tomohisa Tada, Junichi Tazaki, Yoshihiro Kato, Mamoru Hayano, Mitsuru Abe, Natsuhiko Ehara, Tsukasa Inada, Satoshi Kaburagi, Shuichi Hamasaki, Chuwa Tei, Hitoshi Nakashima, Hisao Ogawa, Ryozo Tatami, Satoru Suwa, Akinori Takizawa, Ryuji Nohara, Hisayoshi Fujiwara, Kazuaki Mitsudo, Masakiyo Nobuyoshi, Toru Kita, Takeshi Kimura, and CREDO-Kyoto PCI/CABG registry cohort-2 investigators.
• Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
• Circ Cardiovasc Interv. 2012 Apr 1; 5 (2): 237-46.

BackgroundThere still remain safety concerns on surgical procedures after coronary drug-eluting stents (DES) implantation, and optimal management of perioperative antiplatelet therapy (APT) has not been yet established.Methods And ResultsDuring 3-year follow-up of 12 207 patients (DES=6802 patients and bare-metal stent [BMS] only=5405 patients) who underwent coronary stent implantation in the CREDO-Kyoto registry cohort-2, surgical procedures were performed in 2398 patients (DES=1295 patients and BMS=1103 patients). Surgical procedures (early surgery in particular) were more frequently performed in the BMS group than in the DES group (4.4% versus 1.9% at 42-day and 23% versus 21% at 3-year, log-rank P=0.0007). Cumulative incidences of death/myocardial infarction (MI)/stent thrombosis (ST) and bleeding at 30 days after surgery were low, without differences between BMS and DES (3.5% versus 2.9%, P=0.4 and 3.2% versus 2.1%, P=0.2, respectively). The adjusted risks of DES use relative to BMS use for death/MI/ST and bleeding were not significant (hazard ratio: 1.63, 95% confidence interval: 0.93 to 2.87, P=0.09 and hazard ratio: 0.6, 95% confidence interval: 0.34 to 1.06, P=0.08, respectively). The risks of perioperative single- and no-APT relative to dual-APT for both death/MI/ST and bleeding were not significant; single-APT as compared with dual-APT tended to be associated with lower risk for death/MI/ST (hazard ratio: 0.4, 95% confidence interval: 0.13 to 1.01, P=0.053).ConclusionsSurgical procedures were commonly performed after coronary stent implantation, and the risk of ischemic and bleeding complications in surgical procedures was low. In patients selected to receive DES or BMS, there were no differences in outcomes. Perioperative administration of dual-APT was not associated with lower risk for ischemic events.

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