From the Department of Anesthesiology and Perioperative Medicine.
Division of Biomedical Statistics and Informatics.
Anesth Analg. 2019 Apr;128(4):621-628. doi: 10.1213/ANE.0000000000003408.
Noncardiac surgery (NCS) following percutaneous coronary intervention (PCI) with stenting is sometimes associated with major adverse cardiac events (MACEs). Second-generation drug-eluting stents (DES) were developed to decrease the incidence of MACE seen with bare metal and first-generation DES.
The medical records of all adult patients who underwent second-generation DES placement between July 29, 2008 and July 28, 2011 followed by NCS between September 22, 2008 and July 1, 2013 were reviewed. All episodes of MACE following surgery were recorded.
A total of 282 patients (74.8% male) were identified who underwent NCS after PCI with second-generation DES. MACE occurred in 15 patients (5.3%), including 11 deaths. The incidence of MACE changed significantly with time from PCI to NCS: 17.1%, 10.0%, 0.0%, and 3.1% for patients undergoing NCS at 0-90, 91-180, 181-365, and ≥366 days, respectively. Compared with those having NCS ≥366 days after PCI, the odds ratio for MACE (95% confidence interval) was 6.4 (1.9 to 21.3) at 0-90 days and 3.4 (0.8 to 15.3) at 91-180 days. Seven days prior to NCS, 146 (52%) patients were on dual antiplatelet therapy (DAPT), 106 (38%) were on aspirin, and 30 (11%) did not receive antiplatelet therapy. Excessive surgical bleeding occurred in 19 cases (6.7%). While observed bleeding rates were lowest in those not receiving antiplatelet therapy, there were no statistically significant differences based on the presence or absence of antiplatelet therapy (3% [1/30] for no antiplatelet therapy compared to 6% [6/106] for aspirin monotherapy and 8% [12/146] for DAPT; Fisher exact test: P = .655).
The incidence of MACE in patients with second-generation DES undergoing NCS was 5.3% and was highest in the first 180 days following DES implantation. The rate of excessive surgical bleeding was 6.7% with the highest observed rate in those on DAPT. However, differences by the presence or absence of antiplatelet therapy were not significant, and future large observational studies will be necessary to further define bleeding risk with continued DAPT.
经皮冠状动脉介入治疗（PCI）后行非心脏手术（NCS）有时会导致主要不良心脏事件（MACE）。第二代药物洗脱支架（DES）的开发旨在降低裸金属和第一代 DES 引起的 MACE 发生率。
回顾了 2008 年 7 月 29 日至 2011 年 7 月 28 日期间接受第二代 DES 置入术并于 2008 年 9 月 22 日至 2013 年 7 月 1 日期间行 NCS 的所有成年患者的病历。记录了手术后所有 MACE 事件。
共确定了 282 例（74.8%为男性）接受第二代 DES 行 PCI 后行 NCS 的患者。15 例（5.3%）患者发生 MACE，包括 11 例死亡。从 PCI 到 NCS 的时间，MACE 的发生率显著变化：0-90 天、91-180 天、181-365 天和≥366 天的患者分别为 17.1%、10.0%、0.0%和 3.1%。与 PCI 后≥366 天行 NCS 的患者相比，0-90 天的 MACE 比值比（95%置信区间）为 6.4（1.9 至 21.3），91-180 天为 3.4（0.8 至 15.3）。NCS 前 7 天，146 例（52%）患者接受双联抗血小板治疗（DAPT），106 例（38%）患者服用阿司匹林，30 例（11%）未接受抗血小板治疗。19 例（6.7%）患者发生过度手术出血。尽管未接受抗血小板治疗的患者出血率最低，但基于抗血小板治疗的有无，出血率没有统计学意义（无抗血小板治疗组为 3%[1/30]，阿司匹林单药组为 6%[6/106]，DAPT 组为 8%[12/146]；Fisher 确切检验：P=.655）。
接受第二代 DES 行 NCS 的患者 MACE 发生率为 5.3%，DES 植入后 180 天内发生率最高。DAPT 组过度手术出血率最高，为 6.7%。然而，抗血小板治疗的有无对出血率无显著影响，需要进一步进行大样本观察性研究来确定持续 DAPT 的出血风险。
