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ȣ - 500210 76 |
| Stent-related cardiac events after non-cardiac surgery: Drug-eluting stent vs. Bare metal stent |
| 서울대학교 의과대학 내과학 교실¹ , 서울대병원 순환기 내과² |
| 김학령¹ ,², 이해영¹ ,², 장혁재¹ ,² , 강현재¹ ,² , 조영석¹ ,² , 정우영¹ ,² ,채인호¹ ,² , 김효수¹ ,² , 오병희¹ ,² , 박영배¹ ,² , 구본권¹ ,² |
Background-Incidence of stent associated cardiac events in patients who undergo non-cardiac surgery after drug-eluting stent (DES) implantation is not well known. Methods and Results-We identified 138 patients who underwent non-cardiac surgery after DES implantation at our institution between May 2003 and February 2006. The cardiac outcomes of these patients were evaluated and compared with 101 patients who underwent non-cardiac surgery after bare metal stent (BMS) implantation. Most patients (92 %) stopped antiplatelet agents 5 to 7 days before surgery. Median time interval between coronary intervention and surgery was 209±178 days (range 6~882 days) in DES group and, 569±709 days (range 2~2580 days) in BMS group (P<0.05). The incidence of multiple vessels disease and the number of stents were higher in DES group. Stent size was smaller (2.99±0.37 mm vs 3.24±0.57 mm) and stent length was longer (25.0±6.1 mm vs 20.6±6.3 mm) in the DES group (P<0.05). Perioperative bleeding were occurred in 13 (9.5 %) patients who received DES and 8 (8.5 %) patients who received BMS implantation. Three patients (2.2 %) in DES group developed postoperative cardiac events and none in the BMS group (P=0.2). One patient died due to suspected stent thrombosis and the other two had myocardial infarction due to angiographically proven stent thrombosis followed by successful intervention. The time interval between stent implantation and surgery in those with cardiac events was 6, 264, and 367 days, respectively. Two of three complicated patients had continued dual antiplatelets (aspirin and clopidogrel) for 231 and 362 days before surgery. Stent size was smaller (2.72±0.21 mm vs 3.00±0.37 mm, P=0.034) and left ventricular ejection fraction was lower (46.3±8.3 % vs 56.7±11.2 %, P=0.159) in patients with cardiac complication than in those without complication. Conclusion-Our data shows that peri-operative stent-related thrombotic complications can occur long after DES implantation. Careful perioperative monitoring for symptoms and signs of cardiac events and use of antithrombotic treatment are needed in patients receiving non-cardiac surgery after DES implantation.
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