Abstract 12983: Impact of Door to Balloon Time on Outcome of Patients Presenting With Different Symptom Onset to Door Time

Objective: Delay in reperfusion > 4h in patients with ST elevation myocardial infarction (STEMI) is associated with negative outcomes. We sought out to examine the impact of DTBT on 30-day cardiovascular outcomes and persistent ST elevation (STE) on the post reperfusion EKG, in patients with different symptom onset to door time (SOTDT). Methods: 122 consecutive patients undergoing primary percutaneous coronary intervention for STEMI in a tertiary care county hospital from 2011-2013 are included. All patients had DTBT ≤ 90min. Patients were divided into 3 groups according to their SOTDT: Group1 ≤ 90min, Group2 between 90min and 4h and Group3 >4h. Each group was further divided in 2 subgroups based on median DTBT of the entire population. The primary outcome was a composite endpoint of mortality, re-hospitalization for chest pain or heart failure, repeat revascularization and re-infarction at 30 days. A secondary outcome was persistence of > 50% STE on the post reperfusion EKG. Results: Median SOTDT was 129 min and the median DTBT was 47min for all included patients in the study. The 3 groups had comparable baseline characteristics. The mean DTBT was similar (49±20 min, 47±18 min and 50±16 min, p=0.7). In the 3 groups, the primary outcome was present in 16.7 %, 16.2 % and 35%, respectively (p=0.08) and there was a significant difference in STE resolution: 16.7%, 17.1% and 78.6%, respectively (p<0.001). Group 1 and 3 demonstrate that short DTBT (≤ 47 min) does not affect overall outcomes compared to those with longer DTBT (> 47 min). In group 2, patients with DTBT ≤ 47min had significantly lower persistent STE on EKG (0% vs 36.8%, p=0.002) and a trend to a favorable clinical outcome (table). Conclusion: Patients with intermediate SOTDT seem to benefit mostly from shorter DTBT compared to all other patient groups. Achieving shorter DTBT may have no impact on outcome in patients with very early or very late presentation. Larger studies are needed to further confirm these findings.

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Effect of primary PCI on the recovery of atrioventricular block in inferior STEMI patients with late presentation (>12 hours): insights from a single center 10-year experience

Journal of Investigative Medicine ◽

10.1136/jim-2019-001255 ◽

2020 ◽

Vol 68 (5) ◽

pp. 1011-1014 ◽

Cited By ~ 1

Author(s):

Xiaojuan Fan ◽

Prabindra Maharjan ◽

Ping Liu ◽

Ling Bai

Keyword(s):

Median Time ◽

Atrioventricular Block ◽

Symptom Onset ◽

Strong Association ◽

Coronary Intervention ◽

Late Presentation ◽

Atrioventricular Conduction ◽

Percutaneous Coronary ◽

Infarct Related Artery ◽

St Elevation

There is no definite reperfusion time for inferior ST-elevation myocardial infarction (STEMI) patients presenting later than 12 hours after symptom onset and complicated by newly-developed atrioventricular block (AVB). It is not clear whether the percutaneous coronary intervention (PCI) could facilitate the recovery of AVB in this patient group. We conducted a retrospective study including 52 consecutive inferior STEMI patients with presenting time >12 hours and new onset second or third-degree AVB on admission. All of them underwent PCI. The clinical characteristics, time to PCI and time to AVB improvement after symptom onset were studied. There were 42 males and the mean age was 61±10 years. Median presenting time from symptom onset was 36 hours (ranging 13–192 hours). Median time to PCI was 6.0 days (ranging 1–15 days) and median time of AVB improvement from symptom onset was 5.0 days (ranging 1–15 days). 24 patients got improvement of atrioventricular conduction before PCI procedure (defined as preoperative group) while 28 patients got improvement of atrioventricular conduction after PCI procedure (defined as postoperative group). In the postoperative group, there was a strong association between time to PCI and time to AVB improvement (R2=0.752, p=0.000). No adverse PCI procedure-related complications or death occurred and all the patients got complete AVB recovery at discharge. Early PCI is safe and should be recommended as the priority strategy for late presenting inferior STEMI patients when complicated by AVB. Successful reperfusion of the infarct-related artery is helpful to facilitate AVB recovery in this situation.

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Chronic subdural haematoma during the COVID-19 lockdown period: late presentation with a longer interval from the initial head injury to the final presentation and diagnosis

Chinese Neurosurgical Journal ◽

10.1186/s41016-020-00229-7 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

David Yuen Chung Chan ◽

Wai Sang Poon ◽

Danny Tat Ming Chan ◽

Wai Kit Mak ◽

George Kwok Chu Wong

Keyword(s):

Head Injury ◽

Functional Outcome ◽

Subdural Haematoma ◽

Primary Outcome ◽

The Elderly ◽

Late Presentation ◽

Chronic Subdural Haematoma ◽

Significant Difference ◽

Novel Coronavirus ◽

The Impact

Abstract Background The COVID-19 novel coronavirus is contagious, and the mortality is higher in the elderly population. Lockdown in different parts of the world has been imposed since January 2020. Chronic subdural haematoma (cSDH) has a unique natural history in which symptoms can be non-specific, and the onset is insidious. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation of cSDH. Methods Consecutive adult cSDH patients admitted from 1 March 2020 to 30 April 2020 were reviewed. Exclusion criteria including those who had no definite history of head injury or the diagnosis of cSDH were made from a scheduled follow-up scan. Corresponding data during the same period in 2019 were reviewed for comparison. The primary outcome was the interval between the initial head injury and the final radiological diagnosis of cSDH. Secondary outcomes include Markwalder chronic subdural haematoma grade upon admission, length of stay in the acute hospital, and the modified Rankin scale (mRS) upon discharge. Results For the primary outcome, the average interval between head injury and the diagnosis of cSDH was significantly longer at 56.6 days (49 to 74 days, SD 9.83 days) during the period from March to April 2020, versus 29.4 days (17 to 42 days, SD 8.59 days) in 2019 for the corresponding period (p = 0.00703). There was no significant difference in the functional outcome upon discharge. Conclusions cSDH patients can present late during the COVID-19 lockdown period. The functional outcome was comparable when operations for drainage were timely performed.

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Door-to-balloon Time for ST-elevation MI in the Coronavirus Disease 2019 Era

US Cardiology Review ◽

10.15420/usc.2021.05 ◽

2021 ◽

Vol 15 ◽

Author(s):

Haytham Mously ◽

Nischay Shah ◽

Zachary Zuzek ◽

Ibrahim Alshaghdali ◽

Adham Karim ◽

...

Keyword(s):

Symptom Onset ◽

Treatment Modality ◽

Arrival Time ◽

Coronary Intervention ◽

Hospital Arrival ◽

Improved Outcomes ◽

St Elevation ◽

Door To Balloon ◽

The Impact

In patients presenting with ST-elevation MI, prompt primary coronary intervention is the preferred treatment modality. Several studies have described improved outcomes in patients with door-to-balloon (D2B) and symptom onset-to-balloon (OTB) times of less than 2 hours, but the specific implications of the coronavirus disease 2019 (COVID-19) pandemic on D2B and OTB times are not well-known. This review aims to evaluate the impact of COVID-19 on D2B time and elucidate both the factors that delay D2B time and strategies to improve D2B time in the contemporary era. The search was directed to identify articles discussing the significance of D2B times before and during COVID-19, from the initialization of the database to December 1, 2020. The majority of studies found that onset-of-symptom to hospital arrival time increased in the COVID-19 era, whereas D2B time and mortality were unchanged in some studies and increased in others.

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Abstract P250: The Impact of Recreational Cannabis Legalization on All-cause Hospitalizations and Acute Cardiovascular Event Hospitalizations in Colorado

Circulation ◽

10.1161/circ.141.suppl_1.p250 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Abra M Jeffers ◽

James Lightwood ◽

Salomeh Keyhani

Keyword(s):

Time Series ◽

Cardiovascular Events ◽

Cardiovascular Health ◽

Artery Bypass ◽

Interrupted Time Series ◽

Coronary Intervention ◽

Secondary Outcome ◽

Time Series Regression ◽

Significant Difference ◽

The Impact

Background: Cannabis may have adverse consequences for cardiovascular health. Colorado decriminalized cannabis on November 2012 and retail sales of cannabis began in January 2014. We examined whether the overall rate of hospitalizations and hospitalizations for acute cardiovascular events (ACE) increased in Colorado after legalization. Hypothesis: We hypothesized that the rates of all-cause hospitalizations and ACE would increase post legalization of recreational cannabis. Methods: The State Inpatient Database (SID) for Colorado, available through Healthcare Cost and Utilization Project was analyzed using interrupted time-series methods to assess whether increases in sales of marijuana affected the rates of overall hospitalization and hospitalization for ACE, post legalization of cannabis. The time analyzed included January 2008 through September 2015. We ended the data of analysis on October 1 2015, because ICD-10 codes were implemented in October 2015. The primary outcome, rate of hospitalizations, was measured by total unique inpatient admissions within the SID for each monthly time period. The secondary outcome, ACE, was identified using ICD-9 diagnostic codes for myocardial infarction (410), stroke (430, 431, 433, 434, 436), and ICD-9 procedure codes for coronary artery bypass surgery (36.1x), and percutaneous coronary intervention (36.0x, 0.66). In the interrupted time series regression models we accounted for seasonality and consumption of cigarettes and alcohol using a proxy of sales tax collected each month for cigarettes and alcohol. In the ACE models, we controlled for seasonality, sales of cigarettes and average monthly air temperature. We also examined the effect of legalization on the same outcomes in men and women and different age subgroups. Results: While overall rates of hospitalizations decreased somewhat over the study period, there was no statistically significant difference in hospitalizations rates, neither in the regression intercept (for immediate change) (p=0.94) or slope (p=0.97), after the legalization of recreational cannabis. Similarly, ACE rates decreased over the time frame, but there were no significant changes in rate intercept (p=0.80) or slope (p=0.71) post legalization. The subgroup analyses by age category and gender for hospitalizations and ACE also showed no significant differences in rates pre and post legalization. Conclusions: We found no evidence that overall hospitalizations and hospitalizations for ACE increased due to legalizing recreational cannabis in Colorado. A limitation of our study was that Colorado had already implemented a medical marijuana program in 2000. Recreational legalization may not have led to a significant increase in users. Future studies should examine the link between legalization and cardiovascular events in other states with a different trajectory of legalization.

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Efficacy and Safety of Rhomboid Intercostal Block for Analgesia in Breast Surgery and Thoracoscopic Surgery: A Meta-Analysis

10.21203/rs.3.rs-686513/v1 ◽

2021 ◽

Author(s):

Ruirong Chen ◽

Sheng Su ◽

Haihua Shu

Keyword(s):

Fixed Effects ◽

Primary Outcome ◽

Rating Scale ◽

Breast Surgery ◽

Thoracoscopic Surgery ◽

Secondary Outcome ◽

Efficacy And Safety ◽

Significant Difference ◽

Intercostal Block ◽

The Impact

Abstract BackgroundRhomboid intercostal block (RIB) is a new regional anesthesia technique that provides postoperative analgesia for breast surgery and thoracoscopic surgery. The published papers are not yet fully integrated and do not adequately address the impact and safety of the RIB on postoperative pain.MethodsThe PubMed, Web of Science and Embase were searched from 2016 to 2021 for all available randomized controlled trials (RCTs) that evaluated the analgesic efficacy and safety of RIB after thoracic surgery and breast surgery. Random and fixed-effects meta-analytical models were used where indicated, and between-study heterogeneity was assessed. The primary outcome was Postoperative Numerical Rating Scale (NRS) scores of patients at rest recorded 0-1, 6-8, 24 hours after surgery. The secondary outcomes included rate of postoperative nausea and vomiting (PONV), postoperative fentanyl consumption and presence of complications of the block. ResultsFrom 81 records identified, four studies met our inclusion criteria, including 216 patients (RIB:108 patients; no block: 108 patients). In the primary outcome, RIB group showed significantly lower postoperative NRS at rest at first 0-1 h and 6-8 h (weighted mean difference [WMD] = -1.55; 95% confidence internal [CI] = -2.92 to -0.19; p<0.05), (WMD = -0. 69; 95% CI = -1.29 to -0. 09; p<0. 05). And there was no significant difference between groups in NRS at rest at 24 h (WMD = -0.78; 95% CI = -1.64 to -0.08; p=0.77). Also, RIB group showed significantly lower postoperative NRS of breast surgery and thoracoscopic surgery at 0-1h (WMD = -3.00; 95% CI = -3.13 to -2.87; p<0.01), (WMD = -1.08; 95% CI = -1.98 to -0.18; p<0.05). In the secondary outcome, the analysis also showed RIB group had significant lower of POVN rates (summary relative risk (RR) = 0.212;95%CI = 0.10 to 0.45; p<0. 01) and the postoperative consumption of fentanyl (WMD= -57.52;95%CI = -106.03 to -9.02; p<0. 05). ConclusionThis review shows that RIB was more effective in controlling acute pain after breast surgery and thoracoscopic surgery than general analgesia. And RIB is also a kind of effective and safe bock technology.

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Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

Open Heart ◽

10.1136/openhrt-2021-001716 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001716

Author(s):

Luke Byrne ◽

Roisin Gardiner ◽

Patrick Devitt ◽

Caleb Powell ◽

Richard Armstrong ◽

...

Keyword(s):

Public Health ◽

Public Perception ◽

Coronary Intervention ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Control Group ◽

Ventricular Ejection Fraction ◽

St Elevation ◽

The Impact ◽

Transfer Times

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

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The Impact of Time Interval between Hepatic Resection and Liver Transplantation on Clinical Outcome in Patients with Hepatocellular Carcinoma

Cancers ◽

10.3390/cancers13102398 ◽

2021 ◽

Vol 13 (10) ◽

pp. 2398

Author(s):

Matteo Serenari ◽

Enrico Prosperi ◽

Marc-Antoine Allard ◽

Michele Paterno ◽

Nicolas Golse ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Transplantation ◽

Hepatic Resection ◽

Primary Outcome ◽

Polynomial Regression ◽

Secondary Outcome ◽

Time Interval ◽

Comprehensive Complication Index ◽

Fractional Polynomial ◽

The Impact

Hepatic resection (HR) for hepatocellular carcinoma (HCC) may require secondary liver transplantation (SLT). However, a previous HR is supposed to worsen post-SLT outcomes. Data of patients treated by SLT between 2000 and 2018 at two tertiary referral centers were analyzed. The primary outcome of the study was to analyze the impact of HR on post-LT complications. A Comprehensive Complication Index ≥ 29.6 was chosen as cutoff. The secondary outcome was HCC-related death by means of competing-risk regression analysis. In the study period, 140 patients were included. Patients were transplanted in a median of 23 months after HR (IQR 14–41). Among all the features analyzed regarding the prior HR, only time interval between HR and SLT (time HR-SLT) was an independent predictor of severe complications after LT (OR = 0.98, p < 0.001). According to fractional polynomial regression, the probability of severe complications increased up to 15 months after HR (43%), then slowly decreased over time (OR = 0.88, p < 0.001). There was no significant association between HCC-related death and time HR-SLT at the multivariable competing risks regression model (SHR, 1.06; 95% CI: 0.69–1.62, p = 0.796). This study showed that time HR-SLT was key in predicting complications after LT, without affecting HCC-related death.

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Comparison of prasugrel and ticagrelor for patient with acute coronary syndrome: a systematic review and meta-analysis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1434 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L.C.W Fong ◽

N Lee ◽

A.T Yan ◽

M.Y Ng

Keyword(s):

Acute Coronary Syndrome ◽

Stent Thrombosis ◽

Meta Analysis ◽

Composite Endpoint ◽

Cardiovascular Death ◽

Coronary Syndrome ◽

Primary Composite Endpoint ◽

Significant Difference ◽

St Elevation

Abstract Background Prasugrel and ticagrelor are both effective anti-platelet drugs for patients with acute coronary syndrome. However, there has been limited data on the direct comparison of prasugrel and ticagrelor until the recent ISAR-REACT 5 trial. Purpose To compare the efficacy of prasugrel and ticagrelor in patients with acute coronary syndrome with respect to the primary composite endpoint of myocardial infarction (MI), stroke or cardiac cardiovascular death, and secondary endpoints including MI, stroke, cardiovascular death, major bleeding (Bleeding Academic Research Consortium (BARC) type 2 or above), and stent thrombosis within 1 year. Methods Meta-analysis was performed on randomised controlled trials (RCT) up to December 2019 that randomised patients with acute coronary syndrome to either prasugrel or ticagrelor. RCTs were identified from Medline, Embase and ClinicalTrials.gov using Cochrane library CENTRAL by 2 independent reviewers with “prasugrel” and “ticagrelor” as search terms. Effect estimates with confidence intervals were generated using the random effects model by extracting outcome data from the RCTs to compare the primary and secondary clinical outcomes. Cochrane risk-of-bias tool for randomised trials (Ver 2.0) was used for assessment of all eligible RCTs. Results 411 reports were screened, and we identified 11 eligible RCTs with 6098 patients randomised to prasugrel (n=3050) or ticagrelor (n=3048). The included trials had a follow up period ranging from 1 day to 1 year. 330 events on the prasugrel arm and 408 events on the ticagrelor arm were recorded. There were some concerns over the integrity of allocation concealment over 7 trials otherwise risk of other bias was minimal. Patients had a mean age of 61±4 (76% male; 50% with ST elevation MI; 35% with non-ST elevation MI; 15% with unstable angina; 25% with diabetes mellitus; 64% with hypertension; 51% with hyperlipidaemia; 42% smokers). There was no significant difference in risk between the prasugrel group and the ticagrelor group on the primary composite endpoint (Figure 1) (Risk Ratio (RR)=1.17; 95% CI=0.97–1.41; p=0.10, I2=0%). There was no significant difference between the use of prasugrel and ticagrelor with respect to MI (RR=1.24; 95% CI=0.81–1.90; p=0.31); stroke (RR=1.05; 95% CI=0.66–1.67; p=0.84); cardiovascular death (RR=1.01; 95% CI=0.75–1.36; p=0.95); BARC type 2 or above bleeding (RR=1.17; 95% CI =0.90–1.54; p=0.24); stent thrombosis (RR=1.58; 95% CI =0.90–2.76; p=0.11). Conclusion Compared with ticagrelor, prasugrel did not reduce the primary composite endpoint of MI, stroke and cardiovascular death within 1 year. There was also no significant difference in the risk of MI, stroke, cardiovascular death, major bleeding and stent thrombosis respectively. Figure 1. Primary Objective Funding Acknowledgement Type of funding source: None

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Prognostic value of vascular inflammation biomarkers over clinical risk factors for cardiovascular risk : a meta-analysis

European Journal of Preventive Cardiology ◽

10.1093/eurjpc/zwab061.243 ◽

2021 ◽

Vol 28 (Supplement_1) ◽

Author(s):

S Simantiris ◽

AS Antonopoulos ◽

A Angelopoulos ◽

P Papanikolaou ◽

EK Oikonomou ◽

...

Keyword(s):

Cardiovascular Risk ◽

Cardiovascular Events ◽

Prognostic Value ◽

Primary Outcome ◽

Meta Analysis ◽

Vascular Inflammation ◽

Composite Endpoint ◽

Imaging Biomarkers ◽

Secondary Outcome ◽

Incremental Prognostic Value

Abstract Funding Acknowledgements Type of funding sources: None. Background Measurement of vascular inflammation biomarkers is supported for estimation of residual inflammatory risk and cardiovascular risk stratification, but to date there is no systematic assessment of the added value of such biomarkers in predicting cardiovascular events and their comparative performance. Methods We systematically searched in MEDLINE published literature before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite endpoint of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome. Results We identified 92,507 studies in MEDLINE after duplicates were removed, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, in which 351,628 individuals participated. The combination of high-risk plaque features and Fat attenuation Index (FAI) by CCTA was associated with the highest prognostic value i.e. Δ[c-index] for the composite endpoint per biomarker type (A). In meta-analysis, both plasma and imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, B) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8). The prognostic value of imaging biomarkers significantly surpassed that of plasma biomarkers for the primary outcome (Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10, C). Notably, biomarkers of vascular inflammation offered higher incremental prognostic value in studies with a shorter duration of follow-up (i.e. <5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with <5% cumulative event incidence, D) Conclusions The combination of HRP features and FAI by CCTA imaging had the highest prognostic value for cardiovascular events among plasma or imaging biomarkers of vascular inflammation. CCTA imaging to detect residual inflammatory risk and the vulnerable patient at risk for events is a rational approach to improve risk stratification and prognostication. Abstract Figure.

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Abstract 15502: Clinical Outcomes in Patients Undergoing Non-cardiac Surgery Within 1 Year of Pci

Circulation ◽

10.1161/circ.142.suppl_3.15502 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Davide Cao ◽

Matthew A Levin ◽

Samantha Sartori ◽

Anastasios Roumeliotis ◽

Rishi Chandiramani ◽

...

Keyword(s):

Cardiac Surgery ◽

Antiplatelet Therapy ◽

Care Center ◽

Tertiary Care ◽

Coronary Intervention ◽

Secondary Outcome ◽

Cardiac Events ◽

Bleeding Events ◽

Target Vessel Revascularization ◽

Increased Risk

Introduction: Perioperative cardiovascular events are an important cause of morbidity and mortality associated with non-cardiac surgery (NCS), especially in patients with recent percutaneous coronary intervention (PCI) who require dual antiplatelet therapy. Objective: To illustrate the types and timing of different noncardiac surgeries occurring within 1 year of PCI, and to evaluate the risk of thrombotic and bleeding events according to perioperative antiplatelet management. Methods: All patients undergoing NCS within 1 year of PCI at a tertiary-care center between 2011 and 2018 were included. The primary outcome was major adverse cardiac events (MACE; composite of death, myocardial infarction, stent thrombosis or target vessel revascularization). The key secondary outcome was major bleeding, defined as ≥2 units of blood transfusion. All outcomes were evaluated at 30 days after NCS. Results: A total of 1092 NCS (corresponding to 747 patients) were included and classified by surgical risk (low: 50.9%, intermediate: 38.4%, high: 10.7%) and priority (elective: 88.5%, urgent/emergent: 11.5%). High-risk and urgent/emergent surgeries tended to occur earlier post-PCI compared to low-risk and elective ones ( Figure-A ). The incidence of MACE and bleeding was time-dependent, with an increased risk in surgeries occurring in the first 6 months post-PCI ( Figure-B ). Perioperative antiplatelet cessation occurred in 487 (44.6%) NCS and was more likely for intermediate-risk procedures and after 6 months of PCI. There was no significant association between antiplatelet cessation and cardiac events. Conclusions: Among patients undergoing NCS within 1 year of PCI, the perioperative risk of MACE is inversely related to time from PCI. Preoperative interruption of antiplatelet therapy was observed in less than half of all cases and was not associated with an increased risk of cardiac events.

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