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Published on: November 24, 2014
Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a
Ahmet Tayfun Gurbuz1, Ayhan A Zia, Ali Can Vuran
1Department of Cardiothoracic Surgery and Cardiology, Anadolu Foundation Healthcare System, Gebze Kocaeli, Turkey. atgurbuz@yahoo.com
Insights
Clopidogrel reduces symptom recurrence and adverse cardiac events after off-pump coronary artery bypass graft surgery (OPCAB). Extending clopidogrel use beyond 30 days showed no significant additional benefit for these outcomes.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Off-pump coronary artery bypass graft surgery (OPCAB) is a common procedure.
- Clopidogrel is an antiplatelet medication used to prevent ischemic events.
- Limited data exist on clopidogrel's efficacy in OPCAB patients.
Purpose of the Study:
- To evaluate the effect of short-term and long-term clopidogrel on symptom recurrence and adverse cardiac events after OPCAB.
- To assess the safety of clopidogrel in this patient population.
Main Methods:
- Prospective evaluation of 591 OPCAB patients.
- Comparison between patients receiving clopidogrel for 30 days versus long-term clopidogrel plus aspirin.
- Follow-up for symptom recurrence, adverse cardiac events, and mortality using multivariate Cox regression.
Main Results:
- Postoperative clopidogrel significantly decreased symptom recurrence (angina, heart failure) and adverse cardiac events (myocardial infarction, reintervention, sudden death).
- No significant difference in outcomes between short-term (30 days) and long-term clopidogrel use.
- Bleeding complication rates were similar between clopidogrel/aspirin and aspirin-only groups.
Conclusions:
- Clopidogrel therapy is independently associated with reduced symptom recurrence and adverse cardiac events post-OPCAB.
- Extending clopidogrel therapy beyond 30 days did not yield additional significant benefits for the studied endpoints.
Objective:
Clopidogrel decreases recurrent ischemic events and improves intracoronary stent patency. There are scarce data on the effect of short-term and long-term clopidogrel on symptom recurrence and adverse cardiac events following off-pump coronary artery bypass graft surgery (OPCAB).
Methods:
Postoperative antiplatelet medication use was prospectively evaluated in 591 OPCAB patients. Clopidogrel was administered for 30 days in 186 patients and 139 received long-term clopidogrel (mean 33.6+/-12.0 months) in addition to aspirin. Follow-up was 37.7+/-13.4 months. Symptom recurrence (angina and congestive heart failure), adverse cardiac events (myocardial infarction, coronary reintervention, and sudden cardiac death), and overall mortality were prospectively recorded. Multivariate Cox regression analysis was used to evaluate predictors of end points.
Results:
There was no difference with respect to preoperative risk factors between patient groups. In the multivariate analysis, postoperative clopidogrel independently decreased symptom recurrence (p<0.0001, OR 0.3 [0.15-0.99]; 95% CI) and adverse cardiac events (p<0.0001, OR 0.2 [0.10-0.45]; 95% CI). Clopidogrel receivers had significantly lower angina recurrence, myocardial infarction, coronary reintervention, and sudden cardiac death during follow-up. There was no difference in the incidence of end points between short-term (30 days) and long-term receivers of the drug. There were 17 bleeding complications (4 major and 13 minor) in 15 patients during the follow-up period. Of the 15 patients, 6 were on clopidogrel in addition to aspirin (1.8%) while the remaining 9 were on aspirin (3.3%) only at the time of bleeding (p=0.8).
Conclusions:
Clopidogrel therapy was independently associated with decreased symptom recurrence and adverse cardiac events following OPCAB. Extending clopidogrel use beyond 30 days did not have a significant effect on defined end points.
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