Relationship between postoperative clopidogrel use and subsequent angiographic and clinical outcomes following coronary
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Relationship between postoperative clopidogrel use and subsequent angiographic and clinical outcomes following coronary artery bypass grafting Judson B. Williams • Renato D. Lopes • Gail E. Hafley • T. Bruce Ferguson Jr. • Michael J. Mack • C. Michael Gibson • Robert A. Harrington • Eric D. Peterson Peter K. Smith • Rajendra H. Mehta • John H. Alexander
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Ó Springer Science+Business Media New York 2013
Abstract Dual antiplatelet therapy with both aspirin and clopidogrel is increasingly used after coronary artery bypass grafting (CABG); however, little is known about the safety or efficacy. We sought to determine the relationship between postoperative clopidogrel and clinical and angiographic outcomes following CABG. We evaluated 3,014 patients from PREVENT IV who underwent CABG at 107 US sites. Postoperative antiplatelet therapy was left to physician discretion. Risk-adjusted angiographic and clinical outcomes were compared in patients taking and not taking clopidogrel 30 days post-CABG. At 30 days, 633 (21 %) patients were taking clopidogrel. Clopidogrel users were more likely to have peripheral vascular (15 vs. 11 %) and cerebrovascular disease (17 vs. 11 %), prior myocar-
dial infarction (MI) (46 vs. 41 %), and off-pump surgery (33 vs. 18 %). Clopidogrel use was associated with statistically insignificant higher graft failure (adjusted odds ratio 1.3; 95 % confidence interval [CI] [1.0, 1.7]; P = 0.05). At 5-year follow-up, clopidogrel use was associated with similar composite rates of death, MI, or revascularization (27 vs. 24 %; adjusted hazard ratio 1.1; 95 % CI [0.9, 1.4]; P = 0.38) compared with those not using clopidogrel. There was an interaction between use of cardiopulmonary bypass and clopidogrel with a trend toward lower 5-year clinical events with clopidogrel in patients undergoing off-pump CABG. In this observational analysis, clopidogrel use was not associated with better 5-year outcomes following CABG. There may be better outcomes with clopidogrel among patients having offpump surgery. Adequately powered randomized clinical trials are needed to determine the role of dual antiplatelet therapy after CABG.
J. B. Williams R. D. Lopes G. E. Hafley C. Michael Gibson E. D. Peterson R. H. Mehta J. H. Alexander (&) Duke Clinical Research Institute, Durham, NC, USA e-mail: [email protected]
Keywords Clopidogrel CABG Dual antiplatelet therapy Coronary artery bypass surgery Outcomes
J. B. Williams R. D. Lopes E. D. Peterson P. K. Smith J. H. Alexander Duke University Medical Center, Durham, NC, USA
Introduction
T. Bruce Ferguson Jr. East Carolina University, Greenville, NC, USA M. J. Mack Cardiopulmonary Research Science & Technology Institute, Dallas, TX, USA C. Michael Gibson PERFUSE Angiographic Laboratory, Boston, MA, USA R. A. Harrington Stanford School of Medicine, Stanford, CA, USA
The effectiveness of aspirin to prevent graft occlusion and improve clinical outcomes after coronary artery bypass grafting (CABG) has been established and is endorsed by the Ame
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