Summary
Surgery may necessitate interruption of dual antiplatelet therapy (DAPT) within the
first year after coronary drug-eluting stent (DES) implantation. We conducted a population-based
cohort study to assess the rate of surgery within the first year after DES implantation,
surgery-associated major adverse cardiac events (MACE), reoperation for bleeding within
30 days after surgery, and two nested case-control analyses to explore any association
between preoperative antiplatelet therapy, MACE, and reoperation for bleeding. In
the cohort of 22,654 patients treated with DES, 1,944 patients (8.6 %) underwent moderate-
to high-risk surgery within 12 months. Of these, 62 (3.2 %) experienced MACE and 54
(2.8 %) needed reoperation for bleeding within 30 days. In the nested case-control
analyses of 458 cases and controls, where 70 % (n=324) had a first generation DES,
absence of preoperative antiplatelet therapy was associated with an increased MACE
rate (OR 2.36, 95 % CI 1.02–5.48) compared to single antiplatelet therapy (SAPT) or
DAPT. Preoperative SAPT versus DAPT showed no difference in MACE rates (OR 0.85, 95
% CI 0.30–2.40). Surgery within the first month was associated with increased MACE
rate (OR 4.67, 95 % CI 2.22–9.83) compared to surgery 2–12 months after DES implantation.
Absence of preoperative antiplatelet therapy did not reduce reoperation for bleeding
as compared to patients on SAPT or DAPT (OR 1.32, 95 % CI 0.56–3.12). In conclusion,
absence of preoperative antiplatelet therapy and surgery within the first month after
DES implantation were associated with increased MACE rates.
Keywords
Antiplatelet agents - epidemiological studies - surgery - ischaemic heart disease
