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October 15, 2007
2:00 PM - 4:00 PM
Room Hall D, Area I,
Patients with Coronary Stents and Cardiac Surgery: Preliminary Results of POSTENT Study
Zuzana Vichova, M.D., Yassin Attof, M.D., Catherine Blery-Court, M.D., Maxime Cannesson, M.D., Jean-Jacques Lehot, M.D., Ph.D.
Hospices Civils de Lyon, Hopital Louis Pradel, Bron, France
Introduction: Anesthesiologists have frequently to manage patients with both types of coronary artery stents: bare metal stents (BMS) and/or drug eluting stents (DES). The challenge of perioperative management of these patients is illustrated by the important number of published case reports indicating a high risk of perioperative complications. These patients are exposed to in-stent thrombosis resulting from the withdrawal of the antiplatelet drug (AD) therapy or to bleeding in case of pursuit of the AD therapy. However, no evidence based recommendations for the perioperative management of the AD therapy in patients after coronary artery stenting are available because of the lack of large prospective trials. The goal of the POSTENT study is to create a large multicenter international registry of patients with coronary artery stents undergoing cardiac and non-cardiac surgery to assess the incidence of perioperative morbidity and mortality. We report the preliminary results of this registry in the cardiac surgery group. Data regarding the risk of in-stent thrombosis after cardiac surgery are rare and based on case reports (Alvarez et al., J Thorac Cardiovasc Surg 2003;125:1544-46).

Materiel and Methods: All patients with BMS and/or DES undergoing cardiac surgery are prospectively enrolled. Demographics and cardiovascular risk factors and diseases are recorded. Coronary stenting is analysed with respect to the nature, number and parameters of stents deployed and the indication of stenting. The date of stent placement is recorded for each patient. The perioperative management of AD therapy is detailed. Troponin levels are monitored before surgery and on the first and the second postoperative day. Postoperative bleeding, thrombosis and cardiac complications and the patient outcome are analyzed up to 60 days after surgery.

Results: Between October 2005 and January 2007, 90 patients with 161 coronary artery stents (110 BMS and 51 DES) were enrolled. The surgery was conducted under cardiopulmonary bypass in 62% of cases, off-pump in 38% of cases. Aspirin was discontinued before surgery in 12% and clopidogrel in 93% of patients with a median duration of preoperative withdrawal of 5 and 7 days respectively. Unusual postoperative bleeding occurred in 23% of patients requiring a secondary intervention in 7% of patients. No patient developed in-stent thrombosis with myocardial infarction. Five patients (5.5%) died within 60 days after surgery.

Discussion: These preliminary results of 90 patients enrolled in the multicenter trial POSTENT are currently the largest sample of patients with coronary stents undergoing cardiac surgery. No similar data are available in the medical literature. It is important to estimate the perioperative morbidity/mortality of these patients with regard to the strategies of management of AD therapy.

Anesthesiology 2007; 107: A1258