Rossini Roberta, Angiolillo Dominick J, Musumeci Giuseppe, Capodanno Davide, Lettino Maddalena, Trabattoni Daniela, Pilleri Annarita, Calabria Paolo, Colombo Paola, Bernabò Paola, Ferlini Marco, Ferri Marco, Tarantini Giuseppe, De Servi Stefano, Savonitto Stefano
Dipartimento Cardiovascolare, ASST Papa Giovanni XXIII, Bergamo, Italy.
College of Medicine-Jacksonville, University of Florida, Jacksonville, Florida; Division of Cardiology, University of Florida College of Medicine-Jacksonville; Jacksonville, FL-USA.
Catheter Cardiovasc Interv. 2017 Jan;89(1):E13-E25. doi: 10.1002/ccd.26629. Epub 2016 Jul 12.
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.
There are limited evidence-based recommendations on the perioperative management of antiplatelet therapy in stented patients undergoing surgery.
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.
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).
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. © 2016 Wiley Periodicals, Inc.
本研究旨在确定在接受心脏和非心脏手术的冠状动脉支架置入患者中，遵循关于围手术期抗血小板治疗管理的国家共识建议的可行性和临床影响。
对于接受手术的支架置入患者围手术期抗血小板治疗管理，基于证据的建议有限。
国家共识文件提供的建议应用于意大利19家医院对连续的既往有冠状动脉支架置入史且接受任何类型手术的患者进行的多中心前瞻性登记研究。主要终点是住院期间净不良临床事件（NACE），其由全因死亡、心肌梗死、可能/确定的支架血栓形成以及出血学术研究联盟（BARC）≥3级出血组成。对患者进行30天随访。
共纳入1082例患者。85%的病例遵循了共识建议。围手术期分别有69.7%和10.5%的病例维持使用阿司匹林和双联抗血小板治疗。住院期间NACE发生率为12.7%，在接受心脏手术的患者中显著更高（36.3%对7.3%，P<0.01），主要是由于BARC 3级出血事件（32.3%）。在30天时，接受心脏手术和非心脏手术的患者中主要不良心血管事件（MACE）发生率相似（3.5%对3.5%，P=无显著差异），而心脏手术患者中BARC≥3级出血事件显著更高（36.3%对5.6%，P<0.01）。
该登记研究结果表明，在接受手术的支架置入患者中应用关于围手术期抗血小板治疗管理的国家共识文件是安全可行的。©2016威利期刊公司。
