Department of Anaesthesiology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
Department of Anaesthesiology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain.
Br J Anaesth. 2018 Jan;120(1):67-76. doi: 10.1016/j.bja.2017.11.012. Epub 2017 Nov 21.
Perioperative discontinuation of antiplatelet therapy (APT) in patients with coronary stents has been associated with major adverse cardiac events. Our aim was to analyse the perioperative management of APT in such patients and its relationship to the incidence of major adverse cardiac and cerebrovascular events (MACCE) and major bleeding events (MBE) in noncardiac surgery.
We completed a prospective multicentre observational study of patients with coronary stents undergoing noncardiac surgery in 11 hospitals in Spain. The main objectives were to record perioperative events and prospectively analyse the management of APT, and to assess whether the different preoperative APT regimens were associated with MACCE and MBE.
Of 432 surgical procedures studied, 15% experienced a perioperative MACCE and 37% a MBE. Overall mortality was 3.0%. Presurgical APT was prescribed in 95% of procedures, and was preoperatively discontinued in 15%. Surgery was urgent or emergent in 22% of patients, 31% were ASA IV, and 38% had a Revised Cardiac Risk Index of IV. MACCE were related to recent myocardial infarction (P=0.038), chronic kidney disease (P<0.001), insulin-dependent diabetes (P=0.006) and no preoperative APT (P=0.018). MBE also increased MACCE risk (P<0.001). We found statin therapy (P=0.049) and obesity (P=0.016) to be protective factors for MACCE.
Patients with coronary stents undergoing noncardiac surgery suffer a high incidence of perioperative adverse events, even with perioperative APT. Major adverse cardiac and cerebrovascular events are mainly related to previous medical conditions and perioperative major bleeingn events. Our findings should be treated with caution when applied to an elective surgery population.
NCT01171612.
在接受冠状动脉支架置入术的患者中，围手术期停止抗血小板治疗（APT）与主要不良心脏事件有关。我们的目的是分析此类患者的围手术期 APT 管理及其与非心脏手术中主要不良心脏和脑血管事件（MACCE）和主要出血事件（MBE）的关系。
我们在西班牙 11 家医院进行了一项针对接受非心脏手术的冠状动脉支架置入术患者的前瞻性多中心观察性研究。主要目的是记录围手术期事件，并前瞻性分析 APT 的管理，评估不同术前 APT 方案是否与 MACCE 和 MBE 相关。
在所研究的 432 例手术中，15%发生围手术期 MACCE，37%发生 MBE。总死亡率为 3.0%。95%的手术中进行了术前 APT，其中 15%在术前停止。22%的患者手术紧急或急诊，31%为 ASA IV 级，38%的患者修订心脏风险指数为 IV 级。MACCE 与近期心肌梗死（P=0.038）、慢性肾脏病（P<0.001）、胰岛素依赖型糖尿病（P=0.006）和无术前 APT（P=0.018）有关。MBE 也增加了 MACCE 的风险（P<0.001）。我们发现他汀类药物治疗（P=0.049）和肥胖（P=0.016）是 MACCE 的保护因素。
接受非心脏手术的冠状动脉支架置入术患者即使在围手术期接受 APT 治疗，也会发生高发生率的围手术期不良事件。主要不良心脏和脑血管事件主要与既往的医疗状况和围手术期主要出血事件有关。我们的发现应用于择期手术人群时应谨慎。
NCT01171612。
