Yonsei Med J.  2014 Mar;55(2):345-352.

Prospective and Systematic Analysis of Unexpected Requests for Non-Cardiac Surgery or Other Invasive Procedures during the First Year after Drug-Eluting Stent Implantation

• Kim BK
• Yoon JH
• Shin DH
• Kim JS
• Ko YG
• Choi D
• Lee SH
• Mintz GS
• Jang Y
• Hong MK
• RESET Investigators

Abstract

PURPOSE
Unexpected requests for non-cardiac surgery requiring discontinuation of dual antiplatelet therapy (DAPT) frequently occur in daily clinical practice. The objectives of this study were to evaluate prevalence, timing and clinical outcomes of such unexpected requests for non-cardiac surgery or other invasive procedures during the first year after drug-eluting stents (DESs) implantation.
MATERIALS AND METHODS
We prospectively investigated the prevalence, timing and clinical outcomes of unexpected requests for non-cardiac surgery or other procedures during the first year after DESs implantation in 2117 patients.
RESULTS
The prevalence of requested non-cardiac surgery or invasive procedures was 14.6% in 310 requests and 12.3% in 261 patients. Among 310 requests, those were proposed in 11.3% <1 month, 30.0% between 1 and 3 months, 36.8% between 4 and 6 months and 21.9% between 7 and 12 months post-DES implantation. The rates of actual discontinuation of DAPT and non-cardiac surgery or procedure finally performed were 35.8% (111 of 310 requests) and 53.2% (165 of 310 requests), respectively. On multivariate regression analysis, the most significant determinants for actual discontinuation of DAPT were Endeavor zotarolimus-eluting stent implantation with 3-month DAPT (OR=5.54, 95% CI 2.95-10.44, p<0.001) and timing of request (OR=2.84, 95% CI 1.97-4.11, p<0.001). There were no patients with any death, myocardial infarction, or stent thrombosis related with actual discontinuation of DAPT.
CONCLUSION
Those unexpected requests with premature discontinuation of DAPT were relatively common and continuously proposed during the first year following DES implantation. No death, myocardial infarction or stent thrombosis occurred in patients with actual discontinuation of DAPT.

Keyword

Antiplatelet therapy; drug-eluting stents; coronary artery disease

MeSH Terms

Coronary Artery Disease
Drug-Eluting Stents*
Humans
Methods*
Myocardial Infarction
Prevalence
Prospective Studies*
Regression Analysis
Stents
Thrombosis

Figure

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  Fig. 1 Rate of actual discontinuation of dual antiplatelet therapy (DAPT) and non-cardiac surgery or other invasive procedures finally performed on patients with requests according to the follow-up intervals from DES implantation. The numbers outside the boxes represent the rates of actual discontinuation of DAPT and surgery or procedures finally performed. DES, drug-eluting stent.

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