Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery

• DOI: 10.7326/m17-2341
• Publication Date: 2018-02-19T23:41:26Z
• Authors: Michelle M. Graham; Daniel I. Sessler; Joel L. Parlow; Bruce M. Biccard; Gordon Guyatt; Kate Leslie; Matthew T.V. Chan; Christian S. Meyhoff; Denis Xavier; Alben Sigamani; Priya A. Kumar; Marko Mrkobrada; Deborah J. Cook; Vikas Tandon; Jesus Alvarez-Garcia; Juan Carlos Villar; Thomas W. Painter; Giovanni Landoni; Edith Fleischmann; Andre Lamy; Richard Whitlock; Yannick Le Manach; Meylin Aphang-Lam; Juan P. Cata; Peggy Gao; Nicolaas C.S. Ter...; Pamidimukkala V. ...; Kim A. Jamieson; Amal Bessissow; Gabriela R. Mendoza; Silvia Ramirez; Pierre A. Diemunsch; Salim Yusuf; P.J. Devereaux
• Keywords: Subgroup analysis; Clinical endpoint

Background: Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. Objective: To evaluate benefits and harms perioperative PCI. Design: Nonprespecified subgroup analysis a multicenter factorial trial. Computerized Internet randomization was done between 2010 2013. Patients, clinicians, data collectors, outcome adjudicators were blinded to treatment assignment. (ClinicalTrials.gov: NCT01082874) Setting: 135 centers 23 countries. Patients: Adults aged 45 years or older who had at risk for atherosclerotic disease Exclusions placement bare-metal stent within 6 weeks, drug-eluting 1 year, receipt nonstudy 72 hours before Intervention: Aspirin therapy (overall trial, n = 4998; subgroup, 234) placebo 5012; 236) initiated 4 surgery continued throughout period. Of 470 patients, 99.9% completed follow-up. Measurements: The 30-day primary death nonfatal myocardial infarction; bleeding secondary outcome. Results: In PCI, reduced (absolute reduction, 5.5% [95% CI, 0.4% 10.5%]; hazard ratio [HR], 0.50 [CI, 0.26 0.95]; P interaction 0.036) infarction 5.9% 1.0% 10.8%]; HR, 0.44 0.22 0.87]; 0.021). effect on composite major life-threatening PCI uncertain increase, 1.3% −2.6% 5.2%]). overall population, increased 0.8% 0.1% 1.6%]; 1.22 1.01 1.48]; 0.50). Limitation: small sample. Conclusion: Perioperative may be more likely benefit rather than harm Primary Funding Source: Canadian Institutes Health Research.