Cardiac Risk and Stent Effect on Adverse Perioperative Events

不良围术期患者的心脏风险和支架效应 预期影响：心脏支架植入后需要手术的退伍军人面临糟糕的境遇 围手术期不良事件和死亡率的明确增加风险是由于急性 支架血栓形成并停止抗血小板治疗。因此，手术可能会 显著延迟或修改以降低所感知的风险。目前的手术率是 支架植入尚不清楚。我们的研究将增加关于以下需求的急需知识 支架植入后的后续手术、围手术期不良事件的风险和 手术患者的死亡率。此外，我们将评估收养情况，并 当前心脏支架患者手术指南的有效性。这些 研究结果将使需要手术的退伍军人做出更明智的决策，并为 为未来在这一患者群体中管理抗血小板治疗的试验奠定基础。 项目背景：经皮冠状动脉介入治疗和支架置入术治疗严重狭窄 药物洗脱支架提高了支架的通畅率。然而，急性支架血栓形成是由于 已知的是，停止抗血小板治疗，尤其是在支架置入后第一年内。 发生了。最近，有报道称急性支架血栓形成在 围手术期，导致指南建议将手术推迟12个月 支架置入后，或如果需要更紧急的手术，以继续抗血小板治疗 度过围手术期。标准做法是在5-7天前停止抗血小板治疗 到外科手术，以防止与侵入性手术相关的出血并发症。经验 急性支架术后再手术率及其并发症的证据 用药患者血栓形成、主要心脏不良事件和出血并发症 手术中没有洗脱或裸金属支架。此外，没有对 手术患者的风险是否在一年后降低，以保证延期 做手术。 项目目标：确定患者术后再手术的比率。 心脏支架植入。评估a)心脏支架和手术之间的时间 手术和b)心脏支架类型与围手术期不良事件的比较 带控制装置。评估心脏科医生、麻醉科医生和 外科医生注意支架在围手术期血栓形成和出血的风险。至 评估在当前指南内进行的手术是否比进行的更安全 在指导方针之外。 项目方法：我们提出了一项详细的手术结果分析 Cath实验室心血管评估报告和跟踪系统(CART-CL) 接受后续非心脏外科手术并被跟踪的国家数据库 在国家外科质量改进计划(NSQIP)数据库中。我们还将表演一场 定量调查，以表征关于当前的知识、态度和信念 指南，并描述外科医生、麻醉师和心脏病学家之间的一致性。

Cardiac Risk and Stent Effect on Adverse Perioperative Hawn 1 Anticipated Impact: Veterans needing surgery after cardiac stent implantation face a poorly defined increased risk of adverse peri-operative events and mortality due to the risk for acute stent thrombosis with cessation of antiplatelet therapy. As a consequence, surgery may be significantly delayed or modified to attenuate the perceived risk. The current rate of surgery after stent implantation is unknown. Our study will add much needed knowledge regarding the need for subsequent surgery following stent implantation, the risk of adverse peri-operative events and mortality in patients undergoing surgery. Furthermore, we will assess adoption and effectiveness of current guidelines regarding surgery in patients with cardiac stents. These findings will allow for more informed decision making for veterans needing surgery and lay the groundwork for future trials on management of antiplatelet therapy in this patient population. Project Background: Percutaneous coronary intervention and stenting of critical stenosis with drug eluting stents has increased stent patency rates. However, acute stent thrombosis due to cessation of antiplatelet therapy, especially within the first year post stent placement, is a known occurrence. More recently, there have been reports of acute stent thrombosis in the peri-operative period, leading to guidelines recommending the delay of surgery for 12 months post stent placement, or if more urgent surgery is necessary, to continue antiplatelet therapy through the peri-operative period. Standard practice is to stop antiplatelet therapy 5-7 days prior to surgery to prevent bleeding complications associated with invasive procedures. Empiric evidence about the rate of subsequent surgical procedures and their complications of acute stent thrombosis, major adverse cardiac events and bleeding complications for patients with drug eluting or bare metal stent undergoing surgery is absent. Furthermore, there is no evaluation of whether the risk for surgical patients decreases after the one year period to warrant delaying surgery. Project Objectives: To determine the rate of subsequent surgical procedures in patients after cardiac stent implantation. To assess whether a) time between cardiac stent and surgical procedure, and b) type of cardiac stent is associated with adverse perioperative events compared with controls. To assess current beliefs and practices of cardiologists, anesthesiologists and surgeons regarding the risk of stent thrombosis and bleeding in the peri-operative period. To evaluate whether surgery performed within the current guidelines is safer than those performed outside the guidelines. Project Methods: We propose a detailed analysis of surgical outcomes for patients identified in the Cardiovascular Assessment Reporting and Tracking system for Cath Labs (CART-CL) national database that underwent subsequent non-cardiac surgical procedures and were tracked in the National Surgical Quality Improvement Program (NSQIP) database. We will also perform a quantitative survey to characterize knowledge, attitudes and beliefs concerning the current guidelines and describe the concordance among surgeons, anesthesiologists and cardiologists.