초록접수 현황
| 16F-190 | 포스터 발표 |
Stent Thrombosis after Short-term Discontinuation of P2Y12 Inhibitor (Ticagrelor) Followed by Elective Coronary Artery Bypass Grafting
Sun Kyun Ro, Seung Hyuk Nam, Chul Burm Lee
Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Korea
Background : Dual antiplatelet therapy following percutaneous coronary intervention (PCI) is strongly recommended. Discontinuation of P2Y12 inhibitor for at least 5 days before elective coronary artery bypass grafting (CABG) is also recommended. These two recommendations can conflict with each other when additional CABG is planned to be performed after PCI.
Methods : A 71-year old male patient complaining of anterior chest pain was diagnosed as ST segment elevation myocardial infarction and underwent emergent PCI. Drug-eluting stents (DESs) were implanted at the proximal and mid-right coronary artery (RCA) lesion which had been deemed as a culprit lesion. The secondary CABG was scheduled for the left anterior descending (LAD) lesion where PCI could not be performed due to anatomical difficulty. P2Y12 inhibitor (ticagrelor) was discontinued for 3 days before surgery, while aspirin was preoperatively continued without discontinuation.
Results : Off pump CABG (left internal thoracic artery to LAD) was uneventfully performed. Dual antiplatelet therapy (aspirin + ticagrelor) was restarted on the first postoperative day. During early postoperative period, the patient did not complain of chest pain and his electrocardiogram was normally shown without newly developed left bundle branch block or pathologic Q wave. On the first postoperative day, however, the cardiac biomarkers including CK-MB and Trop-I peaked at 84.3 and 13.94, respectively. Stent thrombosis was revealed on the routine postoperative coronary computed tomography. Additional PCI was successfully performed and thereafter, he has been regularly followed up without any complications.
Conclusion : Inevitable discontinuation of P2Y12 inhibitor after DES implantation may lead to stent thrombosis and post-CABG MI. Therefore, in case of elective CABG following DES implantation, the attending surgeon should judiciously decide when to discontinue P2Y12 inhibitor and when to restart antiplatelet drugs.
Methods : A 71-year old male patient complaining of anterior chest pain was diagnosed as ST segment elevation myocardial infarction and underwent emergent PCI. Drug-eluting stents (DESs) were implanted at the proximal and mid-right coronary artery (RCA) lesion which had been deemed as a culprit lesion. The secondary CABG was scheduled for the left anterior descending (LAD) lesion where PCI could not be performed due to anatomical difficulty. P2Y12 inhibitor (ticagrelor) was discontinued for 3 days before surgery, while aspirin was preoperatively continued without discontinuation.
Results : Off pump CABG (left internal thoracic artery to LAD) was uneventfully performed. Dual antiplatelet therapy (aspirin + ticagrelor) was restarted on the first postoperative day. During early postoperative period, the patient did not complain of chest pain and his electrocardiogram was normally shown without newly developed left bundle branch block or pathologic Q wave. On the first postoperative day, however, the cardiac biomarkers including CK-MB and Trop-I peaked at 84.3 and 13.94, respectively. Stent thrombosis was revealed on the routine postoperative coronary computed tomography. Additional PCI was successfully performed and thereafter, he has been regularly followed up without any complications.
Conclusion : Inevitable discontinuation of P2Y12 inhibitor after DES implantation may lead to stent thrombosis and post-CABG MI. Therefore, in case of elective CABG following DES implantation, the attending surgeon should judiciously decide when to discontinue P2Y12 inhibitor and when to restart antiplatelet drugs.
책임저자: Sun Kyun Ro
Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Gyeonggi-do, Korea
발표자: Sun Kyun Ro, E-mail : skro@hyumc.com