Antiplatelet therapy and outcome in patients undergoing surgery following coronary stenting: Results of the surgery after stenting registry

Roberta Rossini, Dominick J. Angiolillo, Giuseppe Musumeci, Davide Capodanno, Maddalena Lettino, Daniela Trabattoni, Annarita Pilleri, Paolo Calabria, Paola Colombo, Paola Bernabò, Marco Ferlini, Marco Ferri, Giuseppe Tarantini, Stefano De Servi, Stefano Savonitto

Research output: Contribution to journalArticle

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.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
DOIs
Publication statusAccepted/In press - 2016

Fingerprint

Registries
Hemorrhage
Thoracic Surgery
Therapeutics
Stents
Research
Italy
Aspirin
Cause of Death
Thrombosis
Myocardial Infarction
Safety

Keywords

  • Antiplatelet therapy
  • Bleeding
  • Ischemia
  • Stent
  • Surgery

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Antiplatelet therapy and outcome in patients undergoing surgery following coronary stenting : Results of the surgery after stenting registry. / 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.

In: Catheterization and Cardiovascular Interventions, 2016.

Research output: Contribution to journalArticle

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. / Antiplatelet therapy and outcome in patients undergoing surgery following coronary stenting : Results of the surgery after stenting registry. In: Catheterization and Cardiovascular Interventions. 2016.
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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.",
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T2 - Results of the surgery after stenting registry

AU - Rossini, Roberta

AU - Angiolillo, Dominick J.

AU - Musumeci, Giuseppe

AU - Capodanno, Davide

AU - Lettino, Maddalena

AU - Trabattoni, Daniela

AU - Pilleri, Annarita

AU - Calabria, Paolo

AU - Colombo, Paola

AU - Bernabò, Paola

AU - Ferlini, Marco

AU - Ferri, Marco

AU - Tarantini, Giuseppe

AU - De Servi, Stefano

AU - Savonitto, Stefano

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

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KW - Bleeding

KW - Ischemia

KW - Stent

KW - Surgery

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