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Eight-year follow-up of the Clopidogrel After Surgery for Coronary Artery Disease (CASCADE) trial
Ali Hage1, Pierre Voisine1, Fernanda Erthal2
1Division of Cardiac Surgery, Québec Heart and Lung Institute, Québec City, Québec, Canada.
Insights
Adding clopidogrel to aspirin for one year after coronary artery bypass grafting showed a trend toward better outcomes. This treatment reduced native coronary artery disease progression over 8 years.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) is a common procedure to treat severe coronary artery disease.
- Antiplatelet therapy is crucial post-CABG to prevent thrombotic events.
- Long-term effects of dual antiplatelet therapy beyond the first year after CABG require further investigation.
Purpose of the Study:
- To evaluate the long-term clinical outcomes of adding clopidogrel to aspirin for one year after CABG compared to aspirin plus placebo.
- To assess the impact on survival, major adverse cardiac or cerebrovascular events (MACCE), graft patency, and disease progression.
Main Methods:
- A randomized, double-blind trial involving 113 patients post-CABG.
- Patients received aspirin plus either clopidogrel or placebo for one year.
- Long-term follow-up included clinical data collection and coronary computed tomography angiography for graft patency and disease progression.
Main Results:
- At a median 7.6-year follow-up, no significant difference in survival rates between groups (85.5% vs. placebo).
- A trend towards improved freedom from MACCE, including revascularization, was observed with aspirin-clopidogrel (P=0.11).
- Significantly lower incidence of moderate to severe native coronary artery disease progression in the aspirin-clopidogrel group (P=0.02).
Conclusions:
- Adding clopidogrel to aspirin for one year post-CABG demonstrated a significant reduction in native coronary artery disease progression over 8 years.
- A trend towards reduced major adverse cardiac or cerebrovascular events and death was noted.
- No significant differences were observed in graft patency or functional status.
Objective:
In this 8 years' follow-up study, we evaluated the long-term outcomes of the addition of clopidogrel to aspirin during the first year after coronary artery bypass grafting, versus aspirin plus placebo, with respect to survival, major adverse cardiac, or major cerebrovascular events, including revascularization, functional status, graft patency, and native coronary artery disease progression.
Methods:
In the initial Clopidogrel After Surgery for Coronary Artery Disease trial, 113 patients were randomized to receive either daily clopidogrel (n = 56) or placebo (n = 57), in addition to aspirin, in a double-blind fashion for 1 year after coronary artery bypass grafting. All patients were re-evaluated to collect long-term clinical data. Surviving patients with a glomerular filtration rate > 30 mL/min were asked to undergo a coronary computed tomography angiogram to evaluate the late saphenous vein graft patency and native coronary artery disease progression.
Results:
At a median follow-up of 7.6 years, survival rate was 85.5% ± 3.8% (P = .23 between the 2 groups). A trend toward enhanced freedom from all-cause death or major adverse cardiac or cerebrovascular events, including revascularization, was observed in the aspirin-clopidogrel group (P = .11). No difference in functional status or freedom from angina was observed between the 2 groups (P > .57). The long-term patency of saphenous vein graft was 89.11% in the aspirin-clopidogrel group versus 91.23% in the aspirin-placebo group (P = .79). A lower incidence of moderate to severe native disease progression was observed in the aspirin-clopidogrel group versus the aspirin-placebo group (7 out of 122 vs 13 out of 78 coronary segments that showed progression, respectively [odds ratio, 0.3 ± 0.2; 95% confidence interval, 0.1-0.8; P = .02]).
Conclusions:
At 8 years' follow-up, the addition of clopidogrel to aspirin during the first year after coronary artery bypass grafting exhibited a lower incidence of moderate to severe progression of native coronary artery disease and a trend toward higher freedom from major adverse cardiac or cerebrovascular events, including revascularization, or death in the aspirin-clopidogrel group.
Clinical Trial Registration:
http://www.clinicaltrials.gov. Unique identifier: NCT00228423.
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