Context Interruption or maintenance of oral antiplatelet therapy (OAT) during an invasive procedure may result in ischaemic and/or haemorrhagic complications. There is currently a lack of clear guidance regarding the issue of treatment interruption during surgical procedures.
Objective To evaluate the rate of major adverse cardiac and cerebrovascular events (MACCEs) and major or minor bleeding complications and their associated independent correlates in coronary stented patients undergoing urgent or planned non-cardiac surgery.
Design, setting, and patients Prospective, multicentre, observational cohort study of 1134 consecutive patients with coronary stents.
Main outcome measures The co-primary endpoints consisted of the incidence of MACCE and major bleeding within the first 30 days of an invasive procedure.
Results MACCE and haemorrhagic complications were observed in 124 (10.9%) and 108 (9.5%) patients, respectively, within an average time delay from invasive procedure to event of 3.3±3.9 and 5.3±5.3 days. Independent preoperative correlates for MACCE were complete OAT interruption for more than 5 days prior to surgery, preoperative haemoglobin <10 g/dl, creatinine clearance of <30 ml/min and emergency or high-risk surgery. Independent factors for haemorrhagic complications were preoperative haemoglobin <10 g/dl, creatinine clearance between 30 and 60 ml/min, a delay from stent implantation to surgery <3 months and high-risk surgery according to the Lee classification.
Conclusions Patients with coronary stents undergoing an invasive procedure are at high risk of perioperative myocardial infarction including stent thrombosis irrespective of the stent type and major bleeding. Interruption of OAT more than 5 days prior to an invasive procedure is a key player for MACCE.
Clinical Trial Registration NCT01045850.
- RECO stands for “Registre de patients porteurs d'Endoprothèses Coronaires, Opérés”
- coronary intervention
- coronary artery disease (CAD)
- antiplatelet treatment
- general practice
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RECO study participants: O Loutrel (Nantes); S Jaber, M Delay (Montpellier); S Pinchou (Maubeuge); C Blery (Cavaillon); M Spenle (Mulhouse); E Prévost (Rouen); E Samain (Besançon); D Gontier (Hyères); V Piriou, JP Vellard (Lyon-Sud); T Coste, R Leroy (Clermont-Ferrand); P Leroy, R Laplace (Lyon); H Dupont (Amiens); H Charbonneau (Créteil); G Scotto (Berck sur Mer); C Ceddaha (Paris); E Marret (Paris); H Le Hetet (Cesson Sevigne); G Milhem (Angers); A Desroy (Mantes la Jolie); JM Dombey (Marseille); P Bruchet (Avignon); J Bruna, P Balmette (Trélazé); JP Gayard (Voiron); D Blayac (Marseille); E Marcadella (Saint Dizier); JM Guerineau (Villeneuve sur Lot); D Merlin (Redon); G Massardier (St Etienne); M Levy (La Roche Sur Yon); MF Smati (Chalons en Champagne); T François (St Herblain); V Minville (Toulouse); JP Fontes (Castres) ; G Lohmann (Paris); E Gaertner (Nice); E Belaich (La Seyne sur Mer); P Marchesan (Perpignan); P Lavaud (Marseille); A Cherfa (Dracy le Fort); M Gentili (St Gregoire); L Habib (Aix en Provence); H Bouaziz (Nancy).
Funding This study was supported by the French College of Anaesthesia and Intensive Care (Collége Français d'Anesthésie Réanimation) and by an unrestricted grant from Sanofi-Aventis. The funding source did not influence the study design, collection, analysis or interpretation of data; the writing of the report; nor the decision to submit this paper for publication.
Competing interests Drs Albaladejo, Bosson, Samama and Marret received honoraria from Sanofi-Aventis.
Ethics approval This study was conducted with the approval of the IRB (Comité Consultatif de Protection des Personnes dans la Recherche Biomédicale: Lyon B, reference: QH03/2006).
Provenance and peer review Not commissioned; externally peer reviewed.