Cargando…

Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery

BACKGROUNDS: Myocardial injury after non-cardiac surgery (MINS) has recently been accepted as a common complication associated with increased mortality. However, little is known about the treatment of MINS. The aim of this study was to investigate an association between antiplatelet therapy and long...

Descripción completa

Detalles Bibliográficos
Autores principales: Kim, Jihoon, Park, Jungchan, Kwon, Ji-hye, Lee, Jong Hwan, Yang, Kwangmo, Min, Jeong Jin, Lee, Sang-Chol, Park, Seung Woo, Lee, Seung-Hwa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10450040/
https://www.ncbi.nlm.nih.gov/pubmed/37620101
http://dx.doi.org/10.1136/openhrt-2023-002318
_version_ 1785095105164607488
author Kim, Jihoon
Park, Jungchan
Kwon, Ji-hye
Lee, Jong Hwan
Yang, Kwangmo
Min, Jeong Jin
Lee, Sang-Chol
Park, Seung Woo
Lee, Seung-Hwa
author_facet Kim, Jihoon
Park, Jungchan
Kwon, Ji-hye
Lee, Jong Hwan
Yang, Kwangmo
Min, Jeong Jin
Lee, Sang-Chol
Park, Seung Woo
Lee, Seung-Hwa
author_sort Kim, Jihoon
collection PubMed
description BACKGROUNDS: Myocardial injury after non-cardiac surgery (MINS) has recently been accepted as a common complication associated with increased mortality. However, little is known about the treatment of MINS. The aim of this study was to investigate an association between antiplatelet therapy and long-term mortality after MINS. METHODS: From 2010 to 2019, patients with MINS, defined as having a peak high-sensitivity troponin I higher than 40 ng/L within 30 days after non-cardiac surgery, were screened at a tertiary centre. Patients were excluded if they had a history of coronary revascularisation before or during index hospitalisation. Clinical outcomes at 1 year were compared between patients with and without antiplatelet therapy at hospital discharge. The primary outcome was death, and the secondary outcome was major bleeding. RESULTS: Of the 3818 eligible patients with MINS, 940 (24.6%) received antiplatelet therapy at hospital discharge. Patients with antiplatelet therapy had a significantly lower mortality at 1 year than those without antiplatelet therapy (7.5% vs 15.9%, adjusted HR 0.60, 95% CI 0.45 to 0.79, p<0.001). A risk of major bleeding at 1 year was not significantly different between the patients with and without antiplatelet therapy (6.6% vs 7.6%, adjusted HR 0.85, 95% CI 0.62 to 1.17, p=0.324). In propensity score-matched analysis of 886 pairs, patients with antiplatelet therapy had a significantly lower risk of 1-year mortality (adjusted HR 0.53, 95% CI 0.39 to 0.73, p<0.001) than those without antiplatelet therapy. CONCLUSIONS: In patients with MINS, antiplatelet therapy at discharge was associated with decreased 1-year mortality.
format Online
Article
Text
id pubmed-10450040
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-104500402023-08-26 Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery Kim, Jihoon Park, Jungchan Kwon, Ji-hye Lee, Jong Hwan Yang, Kwangmo Min, Jeong Jin Lee, Sang-Chol Park, Seung Woo Lee, Seung-Hwa Open Heart Coronary Artery Disease BACKGROUNDS: Myocardial injury after non-cardiac surgery (MINS) has recently been accepted as a common complication associated with increased mortality. However, little is known about the treatment of MINS. The aim of this study was to investigate an association between antiplatelet therapy and long-term mortality after MINS. METHODS: From 2010 to 2019, patients with MINS, defined as having a peak high-sensitivity troponin I higher than 40 ng/L within 30 days after non-cardiac surgery, were screened at a tertiary centre. Patients were excluded if they had a history of coronary revascularisation before or during index hospitalisation. Clinical outcomes at 1 year were compared between patients with and without antiplatelet therapy at hospital discharge. The primary outcome was death, and the secondary outcome was major bleeding. RESULTS: Of the 3818 eligible patients with MINS, 940 (24.6%) received antiplatelet therapy at hospital discharge. Patients with antiplatelet therapy had a significantly lower mortality at 1 year than those without antiplatelet therapy (7.5% vs 15.9%, adjusted HR 0.60, 95% CI 0.45 to 0.79, p<0.001). A risk of major bleeding at 1 year was not significantly different between the patients with and without antiplatelet therapy (6.6% vs 7.6%, adjusted HR 0.85, 95% CI 0.62 to 1.17, p=0.324). In propensity score-matched analysis of 886 pairs, patients with antiplatelet therapy had a significantly lower risk of 1-year mortality (adjusted HR 0.53, 95% CI 0.39 to 0.73, p<0.001) than those without antiplatelet therapy. CONCLUSIONS: In patients with MINS, antiplatelet therapy at discharge was associated with decreased 1-year mortality. BMJ Publishing Group 2023-08-24 /pmc/articles/PMC10450040/ /pubmed/37620101 http://dx.doi.org/10.1136/openhrt-2023-002318 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Coronary Artery Disease
Kim, Jihoon
Park, Jungchan
Kwon, Ji-hye
Lee, Jong Hwan
Yang, Kwangmo
Min, Jeong Jin
Lee, Sang-Chol
Park, Seung Woo
Lee, Seung-Hwa
Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery
title Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery
title_full Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery
title_fullStr Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery
title_full_unstemmed Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery
title_short Antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery
title_sort antiplatelet therapy and long-term mortality in patients with myocardial injury after non-cardiac surgery
topic Coronary Artery Disease
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10450040/
https://www.ncbi.nlm.nih.gov/pubmed/37620101
http://dx.doi.org/10.1136/openhrt-2023-002318
work_keys_str_mv AT kimjihoon antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery
AT parkjungchan antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery
AT kwonjihye antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery
AT leejonghwan antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery
AT yangkwangmo antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery
AT minjeongjin antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery
AT leesangchol antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery
AT parkseungwoo antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery
AT leeseunghwa antiplatelettherapyandlongtermmortalityinpatientswithmyocardialinjuryafternoncardiacsurgery