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Safety of aortic aneurysm repair 8 weeks after percutaneous coronary intervention for coronary artery disease: a cohort study

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Abstract

Guidelines advice against dual antiplatelet therapy (DAPT) discontinuation less than 12 months after percutaneous coronary intervention with drug-eluting stents (DES-PCI). However, any delay of necessary surgery in patients with descending thoracic (DTA) or abdominal aortic aneurysm (AAA), treated by DES-PCI, increases the risk of aneurysm rupture/dissection. We evaluated the safety of 8-week waiting time between DES-PCI and endovascular aortic repair (EVAR). 1152 consecutive patients with coronary artery disease (CAD) needing elective DTA or AAA repair were enrolled and divided into two groups. Group A included 830 patients treated by DES-PCI for significant CAD who underwent surgery 8 weeks after implantation. Group B included 322 patients treated by DES-PCI at least 6 months before with no residual significant CAD and treated by elective EVAR. Groups were compared according to a composite of death, myocardial infarction, stent thrombosis, cerebrovascular events and bleeding. No aneurysm rupture/dissection occurred while waiting for surgery. Hospital averse events occurred in 6.2% (52/830) group A patients versus 6.5% (21/322) group B patients (p = 0.8). Mortality was 0.7% (6/830) in group A and 0.9% (3/322) in group B (p = 0.7). Multivariate predictors of events were triple vessel DES-PCI (p < 0.001), > 3 stents implanted (p < 0.001), early-generation stents (p < 0.001), diabetes insulin requiring (p = 0.01), stent diameter < 3.0 mm (p = 0.009) and total stented length > 30 mm (p = 0.02). Eight weeks of waiting after DES-PCI in addition to an adequate management of DAPT were safe in terms of cardiac morbidity and bleeding complications. No aneurysm rupture occurred in the interval before surgery.

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References

  1. Elkalioubie A, Haulon S, Duhamel A, Rosa M, Rauch A, Staels B et al (2015) Meta-analysis of abdominal aortic aneurysm in patients with coronary artery disease. Am J Cardiol 116:1451–1456. https://doi.org/10.1016/j.amjcard.2015.07.074

    Article  PubMed  Google Scholar 

  2. Van Kuijk JP, Flu WJ, Dunckelgrun M, Bax JJ, Poldermans D (2009) Coronary artery disease in patients with abdominal aortic aneurysm: a review article. J Cardiovasc Surg 50:93–107

    Google Scholar 

  3. Malas M, Arhuidese I, Qazi U, Black J, Perler B, Freischlag JA (2014) Perioperative mortality following repair of abdominal aortic aneurysms: application of a randomized clinical trial to real-world practice using a validated nationwide data set. JAMA Surg 149:1260–1265. https://doi.org/10.1001/jamasurg.2014.275

    Article  PubMed  Google Scholar 

  4. Schermerhorn ML, Giles KA, Sachs T, Bensley RP, O’Malley AJ, Cotterill P et al (2011) Defining perioperative mortality after open and endovascular aortic aneurysm repair in the US Medicare population. J Am Coll Surg 212:349–355. https://doi.org/10.1016/j.jamcollsurg.2010.12.003

    Article  PubMed  PubMed Central  Google Scholar 

  5. Girardi LN, Rabotnikov Y, Avgerinos DV (2014) Preoperative percutaneous coronary intervention in patients undergoing open thoracoabdominal and descending thoracic aneurysm repair. J Thorac Cardiovasc Surg 147:63–68. https://doi.org/10.1016/j.jtcvs.2013.09.008

    Article  Google Scholar 

  6. Levine GN, Bates ER, Bittl JA, Brindis RG, Fihn SD, Fleisher LA et al (2016) 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease. J Thorac Cardiovasc Surg 152:1243–1275. https://doi.org/10.1016/j.jtcvs.2016.07.044

    Article  PubMed  Google Scholar 

  7. Capodanno D, Angiolillo DJ (2013) Management of antiplatelet therapy in patients with coronary artery disease requiring cardiac and noncardiac surgery. Circulation 128:2785–2798. https://doi.org/10.1161/CIRCULATIONAHA.113.003675

    Article  PubMed  Google Scholar 

  8. Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B et al (2014) 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary. Circulation 130:2215–2245. https://doi.org/10.1161/CIR.0000000000000105

    Article  PubMed  Google Scholar 

  9. Kyo S, Imanaka K, Masuda M, Miyata T, Morita K, Morota T, Japanese Circulation Society Joint Working Group et al (2017) Guidelines for perioperative cardiovascular evaluation and management for noncardiac surgery (JCS 2014). Circ J 81:245–267. https://doi.org/10.1253/circj.cj-66-0135(Epub 2017 Jan 20)

    Article  PubMed  Google Scholar 

  10. Valgimigli M, Bueno H, Byrne RA, Collet JP, Costa F, Jeppsson A et al (2018) ESC National Cardiac Societies 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 39:213–260. https://doi.org/10.1093/eurheartj/ehx419

    Article  PubMed  Google Scholar 

  11. Mannacio VA, Imbriaco M, Iesu S, Giordano AL, Di Tommaso L, Vosa C (2009) 64-slice multidetector computed tomographic evaluation of arterial conduit patency after off-pump coronary artery bypass grafting. Tex Heart Inst J 36:409–415

    PubMed  PubMed Central  Google Scholar 

  12. Yeh RW, Secemsky EA, Kereiakes DJ, Normand SL, Gershlick AH, Cohen DJ et al (2016) Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA 315:1735–1749. https://doi.org/10.1001/jama.2016.3775

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Costa F, van Klaveren D, James S, Heg D, Raber L, Feres F et al (2017) Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 389:1025–1034. https://doi.org/10.1016/S0140-6736(17)30397-5

    Article  PubMed  Google Scholar 

  14. Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GA, Academic Research Consortium et al (2007) Clinical end points in coronary stent trials: a case for standardized definitions. Circulation 115:2344–2351

    Article  Google Scholar 

  15. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Fourth Universal Definition of Myocardial Infarction (2018) Executive group on behalf of the joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) task force for the universal definition of myocardial infarction. J Am Coll Cardiol 2018(72):2231–2264. https://doi.org/10.1016/j.jacc.2018.08.1038

    Article  Google Scholar 

  16. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J et al (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the bleeding academic research consortium. Circulation 123:2736–2747. https://doi.org/10.1161/CIRCULATIONAHA.110.009449

    Article  PubMed  Google Scholar 

  17. Brewster DC, Cronenwett JL, Hallett JW Jr et al (2003) Guidelines for the treatment of abdominal aortic aneurysms. Report of a subcommittee of the joint council of the american association for vascular surgery and society for vascular surgery. J Vasc Surg 37:1106–1117

    Article  Google Scholar 

  18. Schulz-Schüpke S, Byrne RA, Ten Berg JM, Neumann FJ, Han Y, Adriaenssens T, (ISAR-SAFE) Trial Investigators et al (2015) ISAR-SAFE: a randomized, double-blind, placebo-controlled trial of 6 vs. 12 months of clopidogrel therapy after drug-eluting stenting. Eur Heart J 36:1252–1263. https://doi.org/10.1093/eurheartj/ehu523

    Article  CAS  PubMed  Google Scholar 

  19. Fiedler KA, Maeng M, Mehilli J, Schulz-Schüpke S, Byrne RA, Sibbing D et al (2015) The ISAR-TRIPLE trial. J Am Coll Cardiol 65:1619–1629. https://doi.org/10.1016/j.jacc.2015.02.050

    Article  PubMed  Google Scholar 

  20. Franzone A, Piccolo R, Gargiulo G, Ariotti S, Marino M, Santucci A et al (2016) Prolonged vs short duration of dual antiplatelet therapy after percutaneous coronary intervention in patients with or without peripheral arterial disease: a subgroup analysis of the PRODIGY randomized clinical trial. JAMA Cardiol 1:795–803. https://doi.org/10.1001/jamacardio.2016.2811

    Article  PubMed  Google Scholar 

  21. Mehran R, Baber U, Steg PG, Ariti C, Weisz G, Witzenbichler B et al (2013) Cessation of dual antiplatelet treatment and cardiac events after percutaneous coronary intervention (PARIS): 2 year results from a prospective observational study. Lancet 382:1714–1722. https://doi.org/10.1016/s0140-6736(13)61720-1

    Article  PubMed  Google Scholar 

  22. Mannacio V, Meier P, Antignano A, Di Tommaso L, De Amicis V, Vosa C (2014) Individualized strategy for clopidogrel suspension in patients undergoing off-pump coronary surgery for acute coronary syndrome: a case-control study. J Thorac Cardiovasc Surg 148:1299–1306. https://doi.org/10.1016/j.jtcvs.2013.12.011

    Article  CAS  PubMed  Google Scholar 

  23. Feres F, Costa RA, Bhatt DL, Leon MB, Botelho RV, King SB et al (2012) Optimized duration of clopidogrel therapy following treatment with the Endeavor zotarolimus-eluting stent in real-world clinical practice (OPTIMIZE) trial: rationale and design of a large-scale, randomized, multicenter study. Am Heart J 164(810–6):e3. https://doi.org/10.1016/j.ahj.2012.09.009

    Article  CAS  Google Scholar 

  24. Kim BK, Hong MK, Shin DH, Nam CM, Kim JS, Ko YG, RESET Investigators et al (2012) A new strategy for discontinuation of dual antiplatelet therapy: the RESET trial (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation). J Am Coll Cardiol 60:1340–1348. https://doi.org/10.1016/j.jacc.2012.06.043

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiac Surgery Department, Medical School, University Federico II, Via Sergio Pansini 5, 80131, Naples, Italy

    Vito A. Mannacio, Luigi Mannacio, Mario Monaco, Anita Antignano, Raffaele Giordano, Giovanni B. Pinna, Antonino Musumeci & Gabriele Iannelli

  2. Cardiovascular Surgery Department, Pineta Grande Hospital, Castel Volturno, CE, Italy

    Mario Monaco

  3. Department of Cardiology, Azienda Ospedaliera Santobono-Pausillipon, Naples, Italy

    Anita Antignano

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  1. Vito A. Mannacio
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Correspondence to Vito A. Mannacio.

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The authors declare that they have no conflict of interest.

Ethical standards

All authors fully disclose ethical problems and all direct or indirect potential conflict of interest (financial or not financial) and any relationships, including any relationship of their family, with pharmaceutical companies, biomedical device manufacturers or other corporations whose products or services related to the subject matter of the article.

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All patients provided written informed conent to be treated according with our clinical protocol and provided written permission for use of their medical record for research purpose.

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The research involved human participants. Given the retrospective nature of the study, the need for individual patient consent was waived but all patients had preliminarily granted permission for the use of their medical records for research purposes and provided written informed consent to be treated according to our protocol at the time of AA repair.

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Mannacio, V.A., Mannacio, L., Monaco, M. et al. Safety of aortic aneurysm repair 8 weeks after percutaneous coronary intervention for coronary artery disease: a cohort study. Updates Surg 72, 1213–1221 (2020). https://doi.org/10.1007/s13304-020-00729-2

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  • DOI: https://doi.org/10.1007/s13304-020-00729-2

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