• Am. J. Med. · Oct 2023

    Multicenter Study

    Perioperative antiplatelet strategy in patients undergoing non-cardiac surgery within one year after percutaneous coronary intervention.

    • Sang-Hyup Lee, Choongki Kim, Sanghoon Shin, Hyeongsoo Kim, Jong-Kwan Park, Seung-Jin Oh, Sung Gyun Ahn, Sungsoo Cho, Oh-Hyun Lee, Jae Youn Moon, Hoyoun Won, Yongsung Suh, Yun-Hyeong Cho, Jung Rae Cho, Byoung-Kwon Lee, Yong-Joon Lee, Seung-Jun Lee, Sung-Jin Hong, Dong-Ho Shin, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, and Jung-Sun Kim.
    • Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
    • Am. J. Med. 2023 Oct 1; 136 (10): 10261034.e11026-1034.e1.

    BackgroundThe optimal antiplatelet therapy (APT) for patients undergoing non-cardiac surgery within 1 year after percutaneous coronary intervention (PCI) is not yet established.MethodsPatients who underwent non-cardiac surgery within 1 year after second-generation drug-eluting stent implantation were included from a multicenter prospective registry in Korea. The primary endpoint was 30-day net adverse clinical event (NACE), including all-cause death, major adverse cardiovascular event (MACE), and major bleeding events. Covariate adjustment using propensity score was performed.ResultsAmong 1130 eligible patients, 708 (62.7%) continued APT during non-cardiac surgery. After propensity score adjustment, APT continuation was associated with a lower incidence of NACE (3.7% vs 5.5%; adjusted odds ratio [OR], 0.48; 95% confidence interval [CI], 0.26-0.89; P = .019) and MACE (1.1% vs 1.9%; adjusted OR, 0.35; 95% CI, 0.12-0.99; P = .046), whereas the incidence of major bleeding events was not different between the 2 APT strategies (1.7% vs 2.6%; adjusted OR, 0.61; 95% CI, 0.25-1.50; P = .273).ConclusionsThe APT continuation strategy was chosen in a substantial proportion of patients and was associated with the benefit of potentially reducing 30-day NACE and MACE with similar incidence of major bleeding events, compared with APT discontinuation. This study suggests a possible benefit of APT continuation in non-cardiac surgery within 1 year of second-generation drug-eluting stent implantation.Copyright © 2023 Elsevier Inc. All rights reserved.

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