'Bringing on the light' in a complex clinical scenario: Optical coherence tomography–guided discontinuation of antiplatelet therapy in cancer patients with coronary artery disease (PROTECT-OCT registry)
| Autor: | Mehmet Cilingiroglu, Syed Wamique Yusuf, Jake Thomas LeBeau, Pranav Loyalka, Israel Guerrero-Mantilla, Vernon H. Anderson, Emerson C. Perin, Juhee Song, Andre R.M. Paixao, Konstantinos Marmagkiolis, Cezar Iliescu, Dana Elena Giza, Guillherme Silva, Oscar Rosales, Juan Lopez-Mattei |
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| Rok vydání: | 2017 |
| Předmět: |
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medicine.medical_specialty Time Factors medicine.medical_treatment Coronary Artery Disease 030204 cardiovascular system & hematology Coronary Angiography Coronary artery disease 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Restenosis Neoplasms medicine Humans Prospective Studies Registries cardiovascular diseases 030212 general & internal medicine Myocardial infarction Prospective cohort study Aged business.industry Stent Heparin equipment and supplies medicine.disease Coronary Vessels Surgery Discontinuation Apposition surgical procedures operative Withholding Treatment Female Radiology Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors Tomography Optical Coherence Follow-Up Studies medicine.drug |
| Zdroj: | American Heart Journal. 194:83-91 |
| ISSN: | 0002-8703 |
| DOI: | 10.1016/j.ahj.2017.08.015 |
| Popis: | Background Cancer patients with recently placed drug-eluting stents (DESs) often require premature dual antiplatelet therapy (DAPT) discontinuation for cancer-related procedures. Optical coherence tomography (OCT) can identify risk factors for stent thrombosis such as stent malapposition, incomplete strut coverage and in-stent restenosis and may help guide discontinuation of DAPT. Methods We conducted a single-center prospective study in cancer patients with recently placed (1-12 months) DES who required premature DAPT discontinuation. Patients were evaluated with diagnostic coronary angiogram and OCT. Individuals with appropriate stent strut coverage, expansion, apposition, and absence of in-stent restenosis or intraluminal masses were considered low risk and transiently discontinued DAPT to allow optimal cancer therapy. Patients who did not meet all these criteria were considered high risk and underwent further endovascular treatment when appropriate and bridging with low-molecular weight heparin. The incidence of adverse cardiovascular events was assessed after the procedure and at 12 months. Results A total of 40 patients were included. Twenty-seven patients (68%) were considered low risk by OCT criteria and DAPT was transiently discontinued. Thirteen patients (32%) were considered high risk with one or more OCT findings: uncovered stent struts (4 patients, 10%); stent underexpansion (3 patients, 8%); malapposition (8 patients, 20%); in-stent restenosis (2 patients, 5%). The high-risk patients with uncovered stent struts and malapposition underwent additional stent dilatation. There were no cardiovascular events in the low-risk group. One myocardial infarction occurred in the high-risk group. Fourteen non-cardiac deaths were registered before 12 months due to cancer progression or cancer therapy. Conclusion OCT imaging allows identification of low-risk cancer patients with DES placed who may safely discontinue DAPT and proceed with cancer-related surgery or procedures. |
| Databáze: | OpenAIRE |
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