Saia Francesco
Cardio-Thoraco-Vascular Department, University Hospital of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
J Thorac Dis. 2017 Apr;9(4):E373-E377. doi: 10.21037/jtd.2017.03.126.
Up to 15-23% of the patients with percutaneous coronary intervention (PCI) and drug-eluting stent (DES) implantation need a surgical procedure <12 months from PCI. Perioperative risk stratification in these patients is challenging and should take into account many individual clinical and anatomic variables, along with the intrinsic surgical risk for ischemic and bleeding events. The presence of DES has always been considered as a harbinger of doom. In fact, DES are associated with delayed vascular healing and require longer dual antiplatelet treatment. Perioperative pharmacologic management in those patients is intricate because of the tradeoff between the increased thrombotic risk associated with premature DAPT discontinuation and the increased risk of bleeding in the presence of antithrombotics. Whilst most of the studies agree upon the inverse relationship between time from stenting to surgery and cardiac risk, more recent data challenge the previous belief that surgery should be deferred at least 12 months after DES implantation and this safety window could be shortened to <6 months or even less with new-generation DES. The aim of this brief commentary is to critically review available data about cardiac risk associated with surgery in patients with coronary drug-eluting stents.
接受经皮冠状动脉介入治疗（PCI）并植入药物洗脱支架（DES）的患者中，高达15% - 23%的人在PCI术后不到12个月需要接受外科手术。对这些患者进行围手术期风险分层具有挑战性，应考虑许多个体临床和解剖学变量，以及缺血和出血事件的固有手术风险。DES的存在一直被视为厄运的预兆。事实上，DES与血管愈合延迟相关，需要更长时间的双联抗血小板治疗。由于过早停用双联抗血小板治疗（DAPT）会增加血栓形成风险，而使用抗血栓药物时出血风险会增加，这些患者的围手术期药物管理错综复杂。虽然大多数研究都认同从支架置入到手术的时间与心脏风险呈反比关系，但最新数据对先前认为手术应在DES植入后至少推迟12个月的观点提出了挑战，使用新一代DES时，这个安全窗口可以缩短至不到6个月甚至更短。这篇简短评论的目的是批判性地回顾有关冠状动脉药物洗脱支架患者手术相关心脏风险的现有数据。
