Clinical InvestigationDual antiplatelet therapy for perioperative myocardial infarction following CABG surgery
Section snippets
Background
Perioperative myocardial infarction (MI) after surgery has been associated with poor outcomes.1 In coronary artery bypass graft surgery (CABG), perioperative MI occurs in approximately 5–20% of patients,2., 3., 4. depending on the definition used, and is associated with higher in-hospital mortality and worse long-term outcome.5., 6. Since the etiology of perioperative MI can be multifactorial, including global ischemic damage, vein graft failure, and new plaque rupture, the best management of
Methods
We used data collected in 3 clinical trials that enrolled patients undergoing isolated CABG: the PRoject of Ex-vivo Vein graft Engineering via Transfection IV (PREVENT-IV, NCT00042081, 2002–2003),8 MC-1 to Eliminate Necrosis and Damage in CABG (MEND-CABG 2, NCT00402506, 2004–2005),9 and the Reduction in Cardiovascular Events by Acadesine in Patients Undergoing CABG (RED-CABG, NCT00872001, 2009–2010) (Figure 1).10 Patients who underwent planned CABG, had a perioperative MI and received either
Baseline characteristics
A total of 2052 patients experienced a perioperative MI after CABG, and 527 (26%) of the patients were treated with DAPT. The median age was 66 years (25th, 75th 58, 72), 69% were male, and 95% were Caucasian. Baseline major co-mordibities did not differ between patients who received DAPT and those who did not (Table I).
DAPT use for patients with and without perioperative MI were similar across all 3 trials (Table II) and among patients who did not experience a perioperative MI (N = 4871), DAPT
Discussion
While increases in CK-MB following CABG surgery are associated with worse short- and long-term mortality,5., 6., 11. there is a dearth of information on the appropriate management of patients who suffer from perioperative MI during CABG surgery. Since DAPT has been found effective in patients with acute coronary syndrome, we sought to determine if similar efficacy might be evident among patients who suffered a peri-CABG MI. We found the use of DAPT compared with aspirin alone was not associated
Conclusions
One quarter of patients with perioperative MI after CABG receive DAPT. Compared with aspirin alone, DAPT use was not associated with a difference in MI, stroke, or mortality at 30 days, but was associated with fewer re-hospitalizations. Further studies are needed to determine the optimal anti-platelet therapy after perioperative MI in CABG surgery.
Disclosures
Alice Wang- none; Angie Wu- none, Daniel Wojdyla- none; Renato D. Lopes – no conflicts of interest relevant to this work; L. Kristin Newby - no conflicts of interest relevant to this work; Mark F. Newman – none; Peter K. Smith – none; John H. Alexander – no conflicts of interest relevant to this work.
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Thomas Bruce Ferguson, Jr, MD, served as guest editor for this article.