冠状动脉支架植入后肺癌患者行肺切除术的围手术期结局

Perioperative Outcomes of Patients Undergoing Pulmonary Resection for Lung Cancer after Coronary Stenting

背景与目的肺癌患者合并有冠心病是很常见的一种情况,部分患者既往植入冠脉支架并接受抗血小板治疗。对于带有冠脉支架需要行肺切除手术的肺癌患者,围手术期是否停用抗血小板药物仍然存在争议。本研究通过回顾我院的数据来明确这部分特殊人群的围手术期结局。方法回顾性分析了2013年1月-2019年9月冠脉支架术后在北京大学第一医院胸外科行肺切除手术的肺癌患者的临床数据。所有患者术前暂停口服抗血小板药物至少5 d。主要研究终点是院内的心血管并发症和死亡。结果本研究共纳入111例患者。支架放置和肺癌手术间隔的时间在1个月-3个月、3个月-12个月、超过12个月的患者分别为6.3%、13.5%和80.2%。亚肺叶切除、肺叶切除、联合肺叶切除、全肺切除以及肺叶袖式切除的患者分别为10.8%、71.2%、9.0%、2.7%和6.3%。总的心血管并发症发生率为11.6%,包括不稳定心绞痛(n=1,0.9%)、低血压(n=1,0.9%)、充血性心力衰竭(n=2,1.8%)和新发心房纤颤(n=10,9.0%)。本组病例无围手术期死亡,无主要不良心血管事件(major adverse cardiac events,MACE)。结论术前暂停口服抗血小板药物是安全的,围手术期未发生MACE和死亡。

Background and objective It is common for patients with lung cancer to have concomitant coronary artery disease,some of them have underwent coronary stenting and accepted antiplatelet therapy.Whether antiplatelet agents should be continued in the perioperative period remains controversial,especially in patients requiring lung cancer resection with coronary artery stents.We reviewed the data of our institute to clarify the perioperative outcomes of this specific population.Methods We retrospectively analyzed the data on patients who underwent pulmonary resection for lung cancer following coronary stent placement between January 2013 and September 2019 in the Department of Thoracic Surgery in Peking University First Hospital.All of them discontinued oral antiplatelet agents before operation at least 5 days.The primary outcomes were the cardiovascular morbidity and mortality in hospital.Results 111 patients were identified and included in the analysis.The time intervals between stenting and lung surgery were 1-3 months,3-12 months,and more than 12 months in 6.3%,13.5% and 80.2% of the patients,respectively.Sublobectomy,lobectomy,biolobectomy,pneumonectomy and sleeve lobectomy were performed in 10.8%,71.2%,9.0%,2.7% and 6.3% of the patients.The overall incidences of cardiovascular complications were 11.6%,including unstable angina(n=1,0.9%),hypotention(n=1,0.9%),congestive heart failure(n=2,1.8%)and newonset atrial fibrillation(n=10,9.0%).There was no perioperative death.No major adverse cardiac events(MACE)occurred.Conclusion It was safety to discontinued oral antiplatelet agents before operation,with no MACE and death in perioperative period.