Differential effects of dual antiplatelet therapy in patients presented with acute coronary syndrome vs. stable ischaemic heart disease after coronary artery bypass grafting

Choi, Ki Hong; Song, Young Bin; Jeong, Dong Seop; Jang, Yong Ho; Hong, Dongwan; Lee, Sang Yoon; Youn, Taeho; Bak, Minjung; Min, Kyung Min; Lee, Joo Myung; Park, Taek Kyu; Yang, Jeong Hoon; Hahn, Joo‐Yong; Choi, Jin‐Ho; Choi, Seung‐Hyuk; Chung, Sung-Soo; Cho, Yang Hyun; Sung, Kiick; Kim, Wook Sung; Gwon, Hyeon‐Cheol; Lee, Young Tak

doi:10.1093/ehjcvp/pvaa080

Cited by 6 publications

(3 citation statements)

References 23 publications

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“…However, unlike for ACS, scarce data exist on the effect of DAPT after surgical revascularization for stable angina, and it remains unclear whether the presenting symptoms result in clinical differences relevant to secondary antiplatelet therapy. 11 , 13 , 23 , 46 We observed a greater benefit of DAPT in patients with stable angina, possibly because of these patients having fewer factors linked to low responsiveness to clopidogrel. 47 Our results also support the strategy of intensifying platelet inhibition with DAPT after off‐pump CABG and expanding the use of DAPT to those who underwent on‐pump bypass surgery.…”

Section: Discussionmentioning

confidence: 70%

Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery

Zhang

Rao

et al. 2021

JAHA

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Background The optimal antiplatelet therapy after coronary artery bypass grafting remains unclear. We evaluated the association of dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin and clinical outcomes among patients undergoing coronary artery bypass grafting. Methods and Results A total of 18 069 consecutive patients who underwent primary isolated coronary artery bypass grafting between 2013 and 2017 were identified from a contemporary registry, and 10 854 (60.1%) received DAPT with clopidogrel plus aspirin as determined by claimed prescriptions after surgery. Cox regression models with inverse probability of treatment weighting were used to examine the associations between DAPT and outcomes. Patients who received DAPT, compared with those who received aspirin monotherapy, had a lower incidence of a composite of all‐cause death, myocardial infarction, stroke, or repeat revascularization at 6 months (2.9% versus 4.2%; inverse probability of treatment weighting–adjusted hazard ratio [HR], 0.65; 95% CI, 0.55–0.77; P <0.001) as well as death (HR, 0.61; 95% CI, 0.41–0.90), myocardial infarction (HR, 0.55; 95% CI, 0.40–0.74), and stroke (HR, 0.58; 95% CI, 0.46–0.74). The incidence of major bleeding did not differ significantly between the 2 groups (HR, 1.11; 95% CI, 0.69–1.78). Similar results were noted across multiple subgroups as well as when using different analytic methods. Conclusions Among patients undergoing coronary artery bypass grafting, DAPT with clopidogrel plus aspirin as secondary prevention was associated with reduced risk of major adverse cardiovascular and cerebrovascular events within 6 months as compared with aspirin monotherapy, and there was no significant increase in major bleeding.

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Section: Discussionmentioning

confidence: 70%

Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery

Zhang

Rao

et al. 2021

JAHA

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“…This study was a retrospective and prospective, single-center, observational registry of patients with coronary artery disease who underwent CABG (Clinicaltrials.gov, NCT03870815). The study design and population have been described in detail previously [ 16 ]. In brief, between January 2001 and December 2017, a total of 6,691 consecutive patients were enrolled from Samsung Medical Center, Seoul, and Republic of Korea.…”

Section: Methodsmentioning

confidence: 99%

Impact of gender on mid-term prognosis of patients undergoing coronary artery bypass grafting

et al. 2023

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Objectives We evaluated the impact of sex on mid-term prognosis in patients who underwent coronary artery bypass grafting (CABG). Data on gender differences in current management or clinical outcomes after CABG are controversial, and there have been limited data focusing on them. Methods This was a retrospective and prospective, single-center, observational study. Between January 2001 and December 2017, 6613 patients who underwent CABG were enrolled from an institutional registry of Samsung Medical Center, Seoul, Korea (Clinicaltrials.gov, NCT03870815) and divided into two groups according to sex (female group, n = 1679 vs. male group, n = 4934). The primary outcome was cardiovascular death or myocardial infarction (MI) at 5 years. Propensity score matching analysis was performed to reduce confounding factors. Results During a mean follow-up duration of 54 months, a total of 252 cardiovascular death or MIs occurred (female, 78 [7.5%] vs. male, 174 [5.7%]). Multivariate analysis revealed no significant difference in the incidence of cardiovascular death or MI at 5 years between female and male groups (hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.78 to 1.41; p = 0.735). After propensity score matching, the incidence of cardiovascular death or MI was still similar between the two groups (HR 1.08; 95% CI 0.76 to 1.54; p = 0.666). The similarity of long-term outcomes between the two groups was consistent across various subgroups. There was also no significant difference in the risk of 5-year cardiovascular death or MI between males and females according to age (pre- and postmenopausal status) (p for interaction = 0.437). Conclusions After adjusting for baseline differences, sex does not appear to influence long-term risk of cardiovascular death or MI in patients undergoing CABG. Clinical trials.gov number NCT03870815.

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“…Recent large observational studies have yielded discrepant results for the benefit of DAPT in patients undergoing CABG after an ACS event. In a single-center study from Korea including 5782 patients (ACS, n = 3199; SIHD, n = 2583) use of DAPT (95% clopidogrel, 5% ticagrelor) was associated with a lower adjusted risk of cardiovascular death or MI at 5 years than was single antiplatelet therapy (99% aspirin, 1% clopidogrel) among patients with ACS (4.0 versus 7.8%; hazard ratio, 0.521; 95% CI 0.339–0.799; P = 0.003), but not among those with SIHD (4 versus 4%; hazard ratio, 0.991; 95% CI 0.604–1.626; P = 0.971) [ 8 ▪ ]. In a report from the SWEDEHEART Registry of 6558 patients with ACS, no significant difference in the risk of major adverse cardiac events was found at 12 months between patients treated with aspirin and ticagrelor and those treated with aspirin alone (adjusted hazard ratio 0.84; 95% CI 0.85–1.21; P = 0.34), while the risk for major bleeding was higher in patients on DAPT (adjusted hazard ratio 1.90; 96% CI, 1.16–3.13; P = 0.011) [ 9 ▪ ].…”

Section: Clinical Indication For Dual Antiplatelet Therapy After Coro...mentioning

confidence: 99%

Antiplatelet therapy around CABG: the latest evidence

Sandner,

Redfors,

Gaudino

2023

Current Opinion in Cardiology

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Purpose of review The optimal antiplatelet strategy in patients after coronary artery bypass graft (CABG) surgery is unclear. We review the evidence on the efficacy and safety of DAPT after CABG and discuss potential novel antiplatelet strategies that reduce the risk of bleeding without loss of efficacy. Recent findings Adding the potent P2Y12 inhibitor ticagrelor to aspirin for 1 year after CABG is associated with a reduction in the risk of vein graft failure, at the expense of an increased risk of clinically important bleeding. Ticagrelor monotherapy is not associated with better efficacy than aspirin alone, but is not associated with increased bleeding risk. Summary Dual antiplatelet therapy (DAPT) is recommended after acute coronary syndrome events, but aspirin as single antiplatelet therapy remains the cornerstone of antithrombotic therapy in stable ischemic heart disease because of a lack of solid evidence on the benefit of DAPT on clinical outcomes. Shorter duration DAPT, based on the pathophysiology of vein graft failure, may be a promising strategy that requires testing in adequately powered randomized trials.

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Differential effects of dual antiplatelet therapy in patients presented with acute coronary syndrome vs. stable ischaemic heart disease after coronary artery bypass grafting

Cited by 6 publications

References 23 publications

Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery

Dual Antiplatelet Therapy with Clopidogrel and Aspirin Versus Aspirin Monotherapy in Patients Undergoing Coronary Artery Bypass Graft Surgery

Impact of gender on mid-term prognosis of patients undergoing coronary artery bypass grafting

Antiplatelet therapy around CABG: the latest evidence

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