Roberta Rossini1, Dominick J Angiolillo2, Giuseppe Musumeci1, Davide Capodanno3, Maddalena Lettino4, Daniela Trabattoni5, Annarita Pilleri6, Paolo Calabria7, Paola Colombo8, Paola Bernabò9, Marco Ferlini10, Marco Ferri11, Giuseppe Tarantini12, Stefano De Servi10, Stefano Savonitto13. 1. Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy. 2. College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida; Division of Cardiology, University of Florida College of Medicine-Jacksonville; Jacksonville, FL-USA. 3. Dipartimento Di Cardiologia, Ospedale Ferrarotto, Università Di Catania, Italy. 4. U.O.C. Cardiologia Clinica I, Istituto Clinico Humanitas, Rozzano, (MI), Italy; Dipartimento Cardiovascolare, Humanitas Research Hospital, Rozzano, Milano, Italy. 5. Dipartimento Di Scienze Cardiovascolari, Centro Cardiologico Monzino, IRCCS, Università Degli Studi Di Milano, Milano, Italy. 6. SSD Centro di valutazione e consulenza cardiologica, Azienda Ospedaliera Brotzu, Presidio San Michele, Cagliari, Italy. 7. UO Emodinamica, Ospedale Misericordia, Grosseto, USL Toscana Sudest, Italy. 8. Dipartimento Cardiovascolare, ASST Niguarda Grande Ospedale Metropolitano, Milano, Italy. 9. Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genova, Italy. 10. SC Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 11. S.C. Di Cardiologia, Arcispedale S. Maria Nuova, IRCCS, Reggio Emilia, Italy. 12. Dipartimento Di Scienze Cardiache, Toraciche E Vascolari, Università Di Padova, Italia. 13. Dipartimento Cardiovascolare, Ospedale A. Manzoni, Lecco, Italy.
Abstract
OBJECTIVES: The aim of the present study was to define the feasibility and clinical impact of complying with national consensus recommendations on perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery. BACKGROUND: There are limited evidence-based recommendations on the perioperative management of antiplatelet therapy in stented patients undergoing surgery. METHODS: The recommendations provided by the national consensus document were applied in a multicenter, prospective registry of consecutive patients with prior coronary stenting undergoing any type of surgery at 19 hospitals in Italy. The primary end-point was in-hospital net adverse clinical events (NACE) represented by the composite of all-cause death, myocardial infarction, probable/definite stent thrombosis and Bleeding Academic Research Consortium (BARC) grade ≥3 bleeding. Patients were followed for 30 days. RESULTS: A total of 1,082 patients were enrolled. Adherence to consensus recommendations occurred in 85% of the cases. Perioperative aspirin and dual antiplatelet therapy were maintained in 69.7 and 10.5% of the cases, respectively. In-hospital NACE rate was 12.7%, being significantly higher in patients undergoing cardiac surgery (36.3% vs. 7.3%, P < 0.01), mainly due to BARC 3 bleeding events (32.3%). At 30 days, MACE rates were similar (3.5% vs. 3.5%, P = NS) in patients undergoing cardiac and noncardiac surgery, whereas BARC ≥3 bleeding events were significantly higher with cardiac surgery (36.3% vs. 5.6%, P < 0.01). CONCLUSIONS: The results of this registry demonstrate the safety and feasibility of applying a national consensus document on the perioperative management of antiplatelet therapy in stented patients undergoing surgery.
OBJECTIVES: The aim of the present study was to define the feasibility and clinical impact of complying with national consensus recommendations on perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery. BACKGROUND: There are limited evidence-based recommendations on the perioperative management of antiplatelet therapy in stented patients undergoing surgery. METHODS: The recommendations provided by the national consensus document were applied in a multicenter, prospective registry of consecutive patients with prior coronary stenting undergoing any type of surgery at 19 hospitals in Italy. The primary end-point was in-hospital net adverse clinical events (NACE) represented by the composite of all-cause death, myocardial infarction, probable/definite stent thrombosis and Bleeding Academic Research Consortium (BARC) grade ≥3 bleeding. Patients were followed for 30 days. RESULTS: A total of 1,082 patients were enrolled. Adherence to consensus recommendations occurred in 85% of the cases. Perioperative aspirin and dual antiplatelet therapy were maintained in 69.7 and 10.5% of the cases, respectively. In-hospital NACE rate was 12.7%, being significantly higher in patients undergoing cardiac surgery (36.3% vs. 7.3%, P < 0.01), mainly due to BARC 3 bleeding events (32.3%). At 30 days, MACE rates were similar (3.5% vs. 3.5%, P = NS) in patients undergoing cardiac and noncardiac surgery, whereas BARC ≥3 bleeding events were significantly higher with cardiac surgery (36.3% vs. 5.6%, P < 0.01). CONCLUSIONS: The results of this registry demonstrate the safety and feasibility of applying a national consensus document on the perioperative management of antiplatelet therapy in stented patients undergoing surgery.