Key result
Unexpected non-cardiac surgery interrupts DAPT in ~12% of post-DES patients with no subsequent major events.
Why the study?
Unexpected requests for non-cardiac surgery requiring discontinuation of dual antiplatelet therapy frequently occur after drug-eluting stent implantation, but their prevalence, timing, and clinical outcomes were not well characterized.
Does premature discontinuation of DAPT for unexpected non-cardiac surgery increase adverse clinical outcomes in patients during the first year after DES implantation?
Observational (n=2,117)
Open-label
Yes
Does premature discontinuation of DAPT for unexpected non-cardiac surgery increase adverse clinical outcomes in patients during the first year after DES implantation?
Unexpected requests for non-cardiac surgery requiring DAPT discontinuation are relatively common in the first year after DES implantation, but actual discontinuation appears safe with no observed ischemic events in this cohort.
Unexpected non-cardiac surgery requiring DAPT interruption is common post-DES and appears safe without ischemic events; leaves open need for prospective confirmation.
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.
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Kim et al. (2014) conducted an observational in Coronary artery disease treated with drug-eluting stents (n=2,117). Unexpected requests for non-cardiac surgery or invasive procedures vs. No unexpected requests was evaluated on Prevalence of unexpected requests for non-cardiac surgery or invasive procedures. Unexpected requests for non-cardiac surgery requiring premature discontinuation of dual antiplatelet therapy occurred in 12.3% of patients during the first year after drug-eluting stent implantation, with no resulting deaths, myocardial infarctions, or stent thromboses.
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