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Effect of clopidogrel on midterm graft patency following off-pump coronary revascularization surgery
Khalid Ibrahim1, Ole Tjomsland, Dag Halvorsen
1Institute of Circulation and Imaging Techniques, Norwegian University of Science and Technology, Trondheim, Norway.
Insights
Clopidogrel showed a trend towards improved midterm graft patency after off-pump coronary artery bypass grafting, though not statistically significant. Larger studies are needed to confirm these findings for coronary revascularization surgery.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Medical Devices
Background:
- Off-pump coronary artery bypass (OPCAB) surgery aims to improve outcomes by avoiding cardiopulmonary bypass.
- Graft patency is a critical determinant of long-term success after coronary revascularization.
- Antiplatelet therapy is essential to maintain graft patency post-surgery.
Purpose of the Study:
- To evaluate the impact of clopidogrel on midterm graft patency in patients undergoing OPCAB surgery.
- To compare graft patency rates between patients receiving acetyl salicylic acid (ASA) alone versus ASA plus clopidogrel.
Main Methods:
- A retrospective study of 94 patients undergoing OPCAB surgery.
- Patients received either ASA (control group) or ASA plus clopidogrel (clopidogrel group).
- Graft patency was assessed by angiography at a mean follow-up of 185 days, with TIMI flow 2 and 3 considered patent.
Main Results:
- Overall midterm graft patency was 84% in the control group and 93% in the clopidogrel group (not significant).
- Left internal mammary artery (LIMA) graft patency was 92% vs. 96% (not significant).
- Saphenous vein graft patency was 66% vs. 87% (not significant).
Conclusions:
- A trend towards higher graft patency was observed with clopidogrel, but it did not reach statistical significance.
- These preliminary findings suggest a potential benefit of clopidogrel in OPCAB surgery.
- Larger prospective studies are required to validate these results and confirm the role of clopidogrel.
Objective:
The aim of the study was to evaluate the effect of clopidogrel on midterm graft patency following off-pump coronary revascularization surgery.
Design:
Ninety-four consecutive patients who underwent off-pump coronary artery bypass grafting between 1997 and 2002 were studied (58 men, 36 women; 61.7 +/- 9.8 years). The initial 36 patients (control group) received 75 to 160 mg acetyl salicylic acid (ASA) as an antiplatelet agent, whereas the consecutive 58 patients (clopidogrel group) received 75 mg clopidogrel postoperatively in addition to ASA. Intraoperatively, graft flow was assessed with transit-time flowmetry in all patients and the peripheral anastomoses were assessed with epicardial ultrasound in 28 patients. Sixty-two patients underwent angiography after a mean of 185 +/- 92 days. A total of 82 grafts were evaluated angiographically. Grafts with TIMI flow 2 and 3 were assessed as patent.
Results:
At angiographic follow-up, the overall graft patency rate was 84% (31/37) in the control group and 93% (42/45) in the clopidogrel group (P value was not significant [ns]). Graft patency rates for left internal mammary artery (LIMA) grafts were 92% (23/25) versus 96% (28/29) (ns), and for saphenous vein grafts were 66% (7/11) versus 87% (14/16) (ns), respectively.
Conclusion:
The observed trend toward higher patency rates in patients treated with clopidogrel did not reach statistical significance. Further larger studies are necessary to confirm these preliminary results.
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