Abstract
Background. Treatment of patients who need coronary revascularization before undelayable non-cardiac surgery is challenging. Methods. We assessed the safety and efficacy of percutaneous coronary interventions (PCI) using the Avantgarde TM Carbostent (CID, Italy) in patients undergoing PCI before undelayable non-cardiac surgery. The Multiplate analyzer point-of-care was used to assess residual platelet reactivity. One major cardiac events (MACE, defined as death, myocardial infarction, and stent thrombosis and major bleeding) were assessed. Results. 42 consecutive patients were analyzed. Total stent length ≥25 mm was observed in 16 (37%) patients. Multivessel stenting was performed in 11 (31.5%) patients. Clopidogrel was interrupted 5 days before surgery in 35 patients, whereas it was stopped the day of the surgery in 7 patients. Surgery was performed after 27 ± 9 (7–42) days from PCI. MACE occurred in one patient (2.4%; 95% confidence interval: 0.01–13%), who had fatal acute myocardial infarction 3 days after abdominal aortic aneurysm surgery and 12 days after stent implantation. No case of major bleeding in the postoperative phase was observed. Conclusions. The present pilot study suggests that, although at least 10–14 days of dual antiplatelet therapy remain mandatory, the Avantgarde TM stent seems to have a role in patients requiring undelayable surgery.
Highlights
Decision-making for high cardiovascular risk patients requiring undelayable surgical procedure is still challenging
Surgery was performed after 27 ± 9 (7–42) days from percutaneous coronary interventions (PCI)
major adverse cardiac events (MACEs) occurred in one patient (2.4%; 95% confidence interval: 0.01–13%), who had fatal acute myocardial infarction 3 days after abdominal aortic aneurysm surgery and 12 days after stent implantation
Summary
Decision-making for high cardiovascular risk patients requiring undelayable surgical procedure is still challenging. The current guidelines are very restrictive to the prophylactic myocardial revascularization before noncardiac surgery [1]. In this condition percutaneous coronary revascularization (PCI) should be preferred to coronary artery bypass surgery (CABG) [1]. The 30-day DAPT may represent an unacceptable delay for some patient scheduled for undeferrable noncardiac surgery In this challenging scenario, the risk of major cardiac event, due the severe coronary artery disease, should be balanced to the risk of stent thrombosis, associated with premature. One major cardiac events (MACE, defined as death, myocardial infarction, and stent thrombosis and major bleeding) were assessed. The present pilot study suggests that, at least 10–14 days of dual antiplatelet therapy remain mandatory, the AvantgardeTM stent seems to have a role in patients requiring undelayable surgery
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
