Aspirin Monotherapy vs No Antiplatelet Therapy in Stable Patients With Coronary Stents Undergoing Low-to-Intermediate Risk Noncardiac Surgery

被引：8

作者：

Kang, Do-Yoon ^{[1
]}

Lee, Sang-Hyup ^{[2
]}

Lee, Se-Whan ^{[3
]}

Lee, Cheol Hyun ^{[4
]}

Kim, Choongki ^{[5
]}

Jang, Ji-Yong ^{[6
]}

Mehta, Nihar ^{[7
]}

Oh, Jun-Hyok ^{[8
]}

Cho, Young Rak ^{[9
]}

Yoon, Kyung Ho ^{[10
]}

Ahn, Sung Gyun ^{[11
]}

Lee, Jung-Hee ^{[11
]}

Cho, Deok-Kyu ^{[12
,13
]}

Kim, Yongcheol ^{[12
,13
]}

Kim, Jeongsu ^{[14
]}

Cho, Gyeong Hun ^{[15
]}

Lee, Kyu-Sup ^{[16
]}

Park, Hanbit ^{[17
]}

Vural, Mutlu ^{[18
]}

Lim, Young-Hyo ^{[19
]}

Park, Kyoung-Ha ^{[20
]}

Lee, Bong-Ki ^{[21
]}

Lee, Jong-Young ^{[22
]}

Park, Hyun-Woo ^{[23
]}

Yoon, Yong-Hoon ^{[24
]}

Lee, Jae-Hwan ^{[24
]}

Lee, Seung-Yul ^{[25
]}

Park, Kyung Woo ^{[26
,27
]}

Kang, Jeehoon ^{[26
,27
]}

Kim, Hyun Kuk ^{[28
]}

Kang, Si-Hyuck ^{[29
]}

Park, Jae-Hyoung ^{[30
]}

Choi, In-Cheol ^{[31
]}

Yu, Chang Sik ^{[32
,33
]}

Yun, Sung-Cheol ^{[34
]}

Park, Duk-Woo ^{[1
]}

Hong, Myeong-Ki ^{[2
]}

Park, Seung-Jung ^{[1
]}

Kim, Jung-Sun ^{[2
]}

Ahn, Jung-Min ^{[1
]}

机构：

[1] Univ Ulsan, Asan Med Ctr, Div Cardiol, Coll Med, 88 Olymp Ro 43 Gil, Seoul 05505, South Korea

[2] Severance Hosp, Div Cardiol, Seoul, South Korea

[3] Pyeongtaek St Marys Hosp, Pyeongtaek, South Korea

[4] Keimyung Univ, Div Cardiol, Dongsan Hosp, Daegu, South Korea

[5] Ewha Womans Univ, Div Cardiol, Seoul Hosp, Seoul, South Korea

[6] Natl Hlth Insurance Serv Ilsan Hosp, Div Cardiol, Goyang, South Korea

[7] Jaslok Hosp, Div Cardiol, Mumbai, India

[8] Pusan Natl Univ Hosp, Div Cardiol, Busan, South Korea

[9] Dona A Univ Hosp, Div Cardiol, Busan, South Korea

[10] Wonkwang Univ Hosp, Div Cardiol, Iksan, South Korea

[11] Wonju Severance Christian Hosp, Div Cardiol, Wonju, South Korea

[12] Yonsei Univ, Coll Med, Yongin, South Korea

[13] Yongin Severance Hosp, Cardiovasc Ctr, Yongin, South Korea

[14] Haeundae Bumin Hosp, Cardiovasc Ctr, Busan, South Korea

[15] Chonnam Natl Univ, Hosp & Med Sch, Div Cardiol, Gwangju, South Korea

[16] Catholic Univ Korea, Div Cardiol, Daejeon St Marys Hosp, Daejeon, South Korea

[17] Gangneung Asan Hosp, Div Cardiol, Kangnung, South Korea

[18] Bagcilar Educ & Training Hosp, Div Cardiol, Istanbul, Turkiye

[19] Hanyang Univ, Div Cardiol, Seoul Hosp, Seoul, South Korea

[20] Hallym Univ, Div Cardiol, Sacred Heart Hosp, Seoul, South Korea

[21] Kangwon Natl Univ Hosp, Div Cardiol, Chunchon, South Korea

[22] Kangbuk Samsung Hosp, Div Cardiol, Seoul, South Korea

[23] Soonchunhyang Univ Hosp Bucheon, Div Cardiol, Bucheon, South Korea

[24] Chungnam Natl Univ, Div Cardiol, Sejong Hosp, Sejong, South Korea

[25] CHA Univ, Div Cardiol, Bundang Med Ctr, Bundang, South Korea

[26] Seoul Natl Univ Hosp, Cardiovasc Ctr, Dept Internal Med, Seoul, South Korea

[27] Seoul Natl Univ, Coll Med, Seoul, South Korea

[28] Chosun Univ Hosp, Div Cardiol, Gwangju, South Korea

[29] Seoul Natl Univ, Div Cardiol, Bundang Hosp, Bundang, South Korea

[30] Korea Univ, Div Cardiol, Anam Hosp, Seoul, South Korea

[31] Univ Ulsan, Asan Med Ctr, Dept Anesthesiol & Pain Med, Coll Med, Seoul, South Korea

[32] Univ Ulsan, Coll Med, Dept Surg, Seoul, South Korea

[33] Asan Med Ctr, Seoul, South Korea

[34] Univ Ulsan, Asan Med Ctr, Div Biostat, Coll Med, Seoul, South Korea

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2024年 / 84卷 / 24期

关键词：

antiplatelet therapy; aspirin; coronary artery disease; drug-eluting stent; noncardiac surgery; BARE-METAL; ELUTING STENTS; CARDIAC EVENTS; THROMBOSIS; DISCONTINUATION; INTERVENTION; IMPLANTATION; MANAGEMENT;

D O I：

10.1016/j.jacc.2024.08.024

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Current guidelines recommend the perioperative continuation of aspirin in patients with coronary drug-eluting stents (DES) undergoing noncardiac surgery. However, supporting evidence is limited. OBJECTIVES This study aimed to compare continuing aspirin monotherapy vs temporarily holding all antiplatelet therapy before noncardiac surgery in patients with previous DES implantation. METHODS We randomly assigned patients who had received a DES >1 year previously and were undergoing elective noncardiac surgery either to continue aspirin or to discontinue all antiplatelet agents 5 days before noncardiac surgery. Antiplatelet therapy was recommended to be resumed no later than 48 hours after surgery, unless contraindicated. The primary outcome was a composite of death from any cause, myocardial infarction, stent thrombosis, or stroke between 5 days before and 30 days after noncardiac surgery. RESULTS A total of 1,010 patients underwent randomization. Among 926 patients in the modified intention-to-treat population (462 patients in aspirin monotherapy group and 464 patients in the no-antiplatelet therapy group), the primary composite outcome occurred in 3 patients (0.6%) in the aspirin monotherapy group and 4 patients (0.9%) in the no antiplatelet group (difference,-0.2 percentage points; 95% CI:-1.3 to 0.9; P > 0.99). There was no stent thrombosis in either group. The incidence of major bleeding did not differ significantly between groups (6.5% vs 5.2%; P = 0.39), whereas minor bleeding was significantly more frequent in the aspirin group (14.9% vs 10.1%; P = 0.027). CONCLUSIONS Among patients undergoing low-to-intermediate risk noncardiac surgery >1 year after stent implantation primarily with a DES, in the setting of lower-than-expected event rates, we failed to identify a significant difference between perioperative aspirin monotherapy and no antiplatelet therapy with respect to ischemic outcomes or major bleeding. (Perioperative Antiplatelet Therapy in Patients With Drug-eluting Stent Undergoing Noncardiac Surgery [ASSURE-DES]; NCT02797548) (JACC. 2024;84:2380-2389) (c) 2024 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

引用

页码：2380 / 2389

页数：10

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