Incidence and Outcome of Surgical Procedures After Coronary Bare-Metal and Drug-Eluting Stent Implantation A Report From the CREDO-Kyoto PCI/CABG Registry Cohort-2

被引：39

作者：

Tokushige, Akihiro

Shiomi, Hiroki

Morimoto, Takeshi ^{[2
,3
]}

Furukawa, Yutaka ^{[4
]}

Nakagawa, Yoshihisa ^{[5
]}

Kadota, Kazushige ^{[6
]}

Iwabuchi, Masashi ^{[7
]}

Shizuta, Satoshi

Tada, Tomohisa

Tazaki, Junichi

Kato, Yoshihiro

Hayano, Mamoru

Abe, Mitsuru ^{[8
]}

Ehara, Natsuhiko ^{[4
]}

Inada, Tsukasa ^{[9
]}

Kaburagi, Satoshi ^{[10
]}

Hamasaki, Shuichi ^{[11
]}

Tei, Chuwa ^{[11
]}

Nakashima, Hitoshi ^{[12
]}

Ogawa, Hisao ^{[13
]}

Tatami, Ryozo ^{[14
]}

Suwa, Satoru

Takizawa, Akinori

Nohara, Ryuji ^{[15
]}

Fujiwara, Hisayoshi ^{[16
]}

Mitsudo, Kazuaki ^{[6
]}

Nobuyoshi, Masakiyo ^{[7
]}

Kita, Toru

Kimura, Takeshi ^{[1
]}

机构：

[1] Kyoto Univ, Grad Sch Med, Dept Cardiovasc Med, Sakyo Ku, Kyoto 6068507, Japan

[2] Kyoto Univ, Grad Sch Med, Ctr Med Educ, Kyoto 6068507, Japan

[3] Kyoto Univ, Grad Sch Med, Clin Epidemiol Unit, Kyoto 6068507, Japan

[4] Gen Hosp, Kobe City Med Ctr, Dept Cardiovasc Med, Kobe, Hyogo, Japan

[5] Tenri Hosp, Div Cardiol, Tenri, Nara, Japan

[6] Kurashiki Cent Hosp, Div Cardiol, Kurashiki, Okayama, Japan

[7] Kokura Mem Hosp, Div Cardiol, Fuzhou, Peoples R China

[8] Kyoto Med Ctr, Div Cardiol, Kyoto, Japan

[9] Osaka Red Cross Hosp, Div Cardiol, Osaka, Japan

[10] Shizuoka Prefectural Gen Hosp, Div Cardiol, Shizuoka, Japan

[11] Kagoshima Univ, Grad Sch Med, Dept Cardiovasc Resp & Metab Med, Kagoshima 890, Japan

[12] Natl Hosp Org, Kagoshima Med Ctr, Div Cardiol, Kagoshima, Japan

[13] Kumamoto Univ, Grad Sch Med Sci, Dept Cardiovasc Med, Kumamoto 860, Japan

[14] Maizuru Kyosai Hosp, Div Cardiol, Kyoto, Japan

[15] Kitano Hosp, Div Cardiol, Osaka, Japan

[16] Hyogo Kenritsu Amagasaki Hosp, Div Cardiol, Hyogo, Japan

来源：

CIRCULATION-CARDIOVASCULAR INTERVENTIONS | 2012年 / 5卷 / 02期

关键词：

stents; surgery; thrombosis; bleeding; coronary artery disease; NONCARDIAC SURGERY; ANTIPLATELET THERAPY; DISCONTINUATION; THROMBOSIS;

D O I：

10.1161/CIRCINTERVENTIONS.111.963728

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-There still remain safety concerns on surgical procedures after coronary drug-eluting stents (DES) implantation, and optimal management of perioperative antiplatelet therapy (APT) has not been yet established. Methods and Results-During 3-year follow-up of 12 207 patients (DES=6802 patients and bare-metal stent [BMS] only=5405 patients) who underwent coronary stent implantation in the CREDO-Kyoto registry cohort-2, surgical procedures were performed in 2398 patients (DES=1295 patients and BMS=1103 patients). Surgical procedures (early surgery in particular) were more frequently performed in the BMS group than in the DES group (4.4% versus 1.9% at 42-day and 23% versus 21% at 3-year, log-rank P=0.0007). Cumulative incidences of death/myocardial infarction (MI)/stent thrombosis (ST) and bleeding at 30 days after surgery were low, without differences between BMS and DES (3.5% versus 2.9%, P=0.4 and 3.2% versus 2.1%, P=0.2, respectively). The adjusted risks of DES use relative to BMS use for death/MI/ST and bleeding were not significant (hazard ratio: 1.63, 95% confidence interval: 0.93 to 2.87, P=0.09 and hazard ratio: 0.6, 95% confidence interval: 0.34 to 1.06, P=0.08, respectively). The risks of perioperative single- and no-APT relative to dual-APT for both death/MI/ST and bleeding were not significant; single-APT as compared with dual-APT tended to be associated with lower risk for death/MI/ST (hazard ratio: 0.4, 95% confidence interval: 0.13 to 1.01, P=0.053). Conclusions-Surgical procedures were commonly performed after coronary stent implantation, and the risk of ischemic and bleeding complications in surgical procedures was low. In patients selected to receive DES or BMS, there were no differences in outcomes. Perioperative administration of dual-APT was not associated with lower risk for ischemic events. (Circ Cardiovasc Interv. 2012;5:237-246.)

引用

页码：237 / 246

页数：10

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