• M Wąsowicz, S Syed, D N Wijeysundera, Ł Starzyk, D Grewal, T Ragoonanan, P Harsha, G Travis, J Carroll, K Karkouti, and W S Beattie.
• Department of Anesthesia and Pain Management, Toronto General Hospital/University Health Network, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 The Peter Munk Cardiac Centre, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON, Canada M5G 2C4 Department of Anesthesia, University of Toronto, 12 Floor, 123 Edward Street, Toronto, ON Canada M5G 1E2.
• Br J Anaesth. 2016 Apr 1; 116 (4): 493-500.

BackgroundPlatelet inhibition is mandatory therapy after percutaneous coronary intervention (PCI). Withdrawal of oral antiplatelet agents has been linked to increased incidence of postoperative adverse cardiac events in post-PCI patients having non-cardiac surgery (NCS). There is limited knowledge of temporal changes in platelet inhibition in this high-risk surgical population. We therefore performed a multicentre prospective cohort study evaluating perioperative platelet function and its association with postoperative major adverse cardiac events (MACE).MethodsIn 201 post-PCI patients having NCS, we assessed the association between platelet function and postoperative MACE. We performed perioperative platelet function testing using a platelet mapping assay (PMA). Troponin-I was measured every 8 h for 2 days, then daily until day 5. Myocardial infarction was assessed using the third universal definition. We used multivariable logistic regression to assess the association between platelet inhibition and MACE.ResultsMajor adverse cardiac events occurred in 40 patients within 30 days of surgery. Thirty-two of these events were non-ST-elevation myocardial infarction, four ST-elevation myocardial infarction, and four exacerbation of congestive heart failure. We were unable to show an association between platelet inhibition and MACE. The PMA showed declining levels of platelet inhibition the longer the antiplatelet therapy was withheld before surgery. Logistic regression did not show an association between preoperative platelet function or the type of stent and MACE. We found an increased cardiac risk of MACE after surgery within 6 weeks of PCI.ConclusionsThe incidence of MACE in patients undergoing NCS after previous PCI is high in spite of adequate perioperative antiplatelet therapy.Clinical Trial RegistrationNCT 01707459 (registered at http://www.clinicaltrials.gov).© The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

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