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01-12-2020 | Aortic Aneurysm | Original Article

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

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

Published in: Updates in Surgery | Issue 4/2020

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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Title: Safety of aortic aneurysm repair 8 weeks after percutaneous coronary intervention for coronary artery disease: a cohort study
Authors: Vito A. Mannacio
Luigi Mannacio
Mario Monaco
Anita Antignano
Raffaele Giordano
Giovanni B. Pinna
Antonino Musumeci
Gabriele Iannelli
Publication date: 01-12-2020
Publisher: Springer International Publishing
Keywords: Aortic Aneurysm
Aneurysm
Aortic Aneurysm
Aneurysm
Abdominal Aortic Aneurysm
Abdominal Aortic Aneurysm
Myocardial Infarction
Arterial Diseases
Published in: Updates in Surgery / Issue 4/2020
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-020-00729-2

At a glance: The STEP trials

Springer Medicine

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

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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