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

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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Correspondence to Vito A. Mannacio.

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The authors declare that they have no conflict of interest.

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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.

Research involving human participants and/or animals

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 (2020). https://doi.org/10.1007/s13304-020-00729-2

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Keywords

  • Percutaneous coronary intervention
  • Aortic aneurysm
  • Antiplatelet therapy
  • Cardiac risk