안정민 (울산대학교 의과대학, 서울아산병원)

한빛사논문

조회40

울산대학교 의과대학, 서울아산병원

J. Am. Coll. Cardiol., Aug 29 2024, S0735-1097(24)08196-8 | https://doi.org/10.1016/j.jacc.2024.08.024 Aspirin Monotherapy vs No Antiplatelet Therapy in Stable Patients With Coronary Stents Undergoing Low-to-Intermediate Risk Noncardiac Surgery

Do-Yoon Kang MD ^a∗, Sang-Hyup Lee MD ^b∗, Se-Whan Lee MD ^c, Cheol Hyun Lee MD ^d, Choongki Kim MD ^e, Ji-Yong Jang MD ^f, Nihar Mehta MD ^g, Jun-Hyok Oh MD ^h, Young Rak Cho MDⁱ, Kyung Ho Yoon MD ^j, Sung Gyun Ahn MD ^k, Jung-Hee Lee MD^k, Deok-Kyu Cho MD ^l, Yongcheol Kim MD ^l, Jeongsu Kim MD ^m, Gyeong Hun Cho MD ⁿ, Kyu-Sup Lee MD ^o, Hanbit Park MD ^p, Mutlu Vural MD ^q, Young-Hyo Lim MD ^r, Kyoung-Ha Park MD ^s, Bong-Ki Lee MD ^t, Jong-Young Lee MD ^u, Hyun-Woo Park MD^v, Yong-Hoon Yoon MD ^w, Jae-Hwan Lee MD ^w, Seung-Yul Lee MD ^x, Kyung Woo Park MD ^y, Jeehoon Kang MD ^y, Hyun Kuk Kim MD ^z, Si-Hyuck Kang MD ^aa, Jae-Hyoung Park MD ^bb, In-Cheol Choi MD ^cc, Chang Sik Yu MD ^dd, Sung-Cheol Yun PhD ^ee, Duk-Woo Park MD^a, Myeong-Ki Hong MD ^b, Seung-Jung Park MD ^a, Jung-Sun Kim MD ^b, Jung-Min Ahn MD ^a the ASSURE DES Investigators†

^aDivision of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^bDivision of Cardiology, Severance Hospital, Seoul, Korea

^cPyeongtaek St Mary’s Hospital, Pyeongtaek, Korea

^dDivision of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea

^eDivision of Cardiology, Ewha Womans University Seoul Hospital, Seoul, Korea

^fDivision of Cardiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea

^gDivision of Cardiology, Jaslok Hospital, Mumbai, India

^hDivision of Cardiology, Pusan National University Hospital, Busan, Korea

ⁱDivision of Cardiology, Dona-A University Hospital, Busan, Korea

^jDivision of Cardiology, Wonkwang University Hospital, Iksan, Korea

^kDivision of Cardiology, Wonju Severance Christian Hospital, Wonju, Korea

^lYonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Korea

^mCardiovascular Center, Haeundae Bumin Hospital, Busan, Korea

ⁿDivision of Cardiology, Chonnam National University Hospital and Medical School, Gwangju, Korea

^oDivision of Cardiology, The Catholic University of Korea Daejeon St Mary's Hospital, Daejeon, Korea

^pDivision of Cardiology, Gangneung Asan Hospital, Gangneung, Korea

^qDivision of Cardiology, Bagcilar Education and Training Hospital, Istanbul, Türkiye

^rDivision of Cardiology, Hanyang University Seoul Hospital, Seoul, Korea

^sDivision of Cardiology, Hallym University Sacred Heart Hospital, Seoul, Korea

^tDivision of Cardiology, Kangwon National University Hospital, Chuncheon, Korea

^uDivision of Cardiology, Kangbuk Samsung Hospital, Seoul, Korea

^vDivision of Cardiology, Soonchunhyang University Hospital Bucheon, Bucheon, Korea

^wDivision of Cardiology, Chungnam National University Sejong Hospital, Sejong, Korea

^xDivision of Cardiology, CHA University Bundang Medical Center, Bundang, Korea

^yCardiovascular Center, Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea

^zDivision of Cardiology, Chosun University Hospital, Gwangju, Korea

^aaDivision of Cardiology, Seoul National University Bundang Hospital, Bundang, Korea

^bbDivision of Cardiology, Korea University Anam Hospital, Seoul, Korea

^ccDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^ddDepartment of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea

^eeDivision of Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

^∗Drs. D.-Y. Kang and S.-H. Lee contributed equally to this work.

Address for correspondence: Dr Jung-Min Ahn

^†A full list of the investigators in the ASSURE DES trial is provided in the Supplemental Appendix

Abstract

Background: Current guidelines recommend the perioperative continuation of aspirin in patients with coronary drug-eluting stents (DES) undergoing noncardiac surgery. However, supporting evidence is limited.

Objectives: This study aimed to compare continuing aspirin monotherapy vs temporarily holding all antiplatelet therapy before noncardiac surgery in patients with previous DES implantation.

Methods: We randomly assigned patients who had received a DES >1 year previously and were undergoing elective noncardiac surgery either to continue aspirin or to discontinue all antiplatelet agents 5 days before noncardiac surgery. Antiplatelet therapy was recommended to be resumed no later than 48 hours after surgery, unless contraindicated. The primary outcome was a composite of death from any cause, myocardial infarction, stent thrombosis, or stroke between 5 days before and 30 days after noncardiac surgery.

Results: A total of 1,010 patients underwent randomization. Among 926 patients in the modified intention-to-treat population (462 patients in aspirin monotherapy group and 464 patients in the no-antiplatelet therapy group), the primary composite outcome occurred in 3 patients (0.6%) in the aspirin monotherapy group and 4 patients (0.9%) in the no antiplatelet group (difference, -0.2 percentage points; 95% CI: -1.3 to 0.9; P > 0.99). There was no stent thrombosis in either group. The incidence of major bleeding did not differ significantly between groups (6.5% vs 5.2%; P = 0.39), whereas minor bleeding was significantly more frequent in the aspirin group (14.9% vs 10.1%; P = 0.027).

Conclusions: Among patients undergoing low-to-intermediate risk noncardiac surgery >1 year after stent implantation primarily with a DES, in the setting of lower-than-expected event rates, we failed to identify a significant difference between perioperative aspirin monotherapy and no antiplatelet therapy with respect to ischemic outcomes or major bleeding. (Perioperative Antiplatelet Therapy in Patients With Drug-eluting Stent Undergoing Noncardiac Surgery [ASSURE-DES]; NCT02797548).

논문정보

형식Research article
게재일2024년 08월 (BRIC 등록일 2024-09-11)
연구진국내(교신)+국외 연구진
분야 의약학 > 응용의학

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