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Efficacy of Extended Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting in Patients With High
Woo Jin Jang1, Ki Hong Choi2, Chang Hoon Kim3
1Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine.
Insights
Dual antiplatelet therapy (DAPT) for over 12 months significantly improves outcomes for coronary artery bypass grafting (CABG) patients with high inflammatory risk, reducing death or myocardial infarction (MI).
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Coronary artery bypass grafting (CABG) patients with high inflammatory risk present unique challenges for long-term prognosis.
- Evaluating the impact of dual antiplatelet therapy (DAPT) duration is crucial for optimizing post-CABG care in this population.
Purpose of the Study:
- To assess the efficacy of prolonged dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) on long-term outcomes in CABG patients with high inflammatory risk.
- To determine if DAPT for ≥12 months reduces the risk of all-cause death or myocardial infarction (MI) post-CABG.
Main Methods:
- Analysis of 2,409 patients undergoing isolated CABG with elevated high-sensitivity C-reactive protein (hs-CRP >2.0 mg/L).
- Comparison of outcomes between patients receiving DAPT for ≥12 months (n=545) and SAPT (n=1,864).
- Utilized propensity score (PS) matching to control for confounding variables and selection bias.
Main Results:
- The DAPT group showed a significantly lower incidence of the primary outcome (all-cause death or MI) compared to the SAPT group (7.5% vs. 13.3%; HR 0.42).
- Post-PS matching, the reduced risk of the primary outcome in the DAPT group persisted (HR 0.36).
- Benefits of prolonged DAPT were observed consistently across various patient subgroups.
Conclusions:
- Prolonged DAPT (≥12 months) is associated with significantly improved long-term prognosis in CABG patients with high inflammatory risk.
- This duration of DAPT demonstrates a marked reduction in the combined risk of all-cause death or myocardial infarction compared to SAPT.
Background:
This study evaluated the efficacy of dual antiplatelet therapy (DAPT) on the long-term prognosis of coronary artery bypass grafting (CABG) patients with high inflammatory risk.
Methods And Results:
We analyzed 2,409 patients who underwent isolated CABG between January 2001 and December 2017 and had baseline high-sensitivity C-reactive protein (hs-CRP) levels >2.0 mg/L. Patients were divided into 2 groups: those on DAPT for ≥12 months (n=545) and those on single antiplatelet therapy (SAPT; n=1,864). The primary outcome was all-cause death or myocardial infarction (MI) after CABG. Propensity score (PS) matching was used to minimize confounding factors and selection bias. During follow-up, the ≥12-month DAPT group had a significantly lower risk of the primary outcome than the SAPT group (7.5% vs. 13.3%; hazard ratio [HR] 0.42; 95% confidence interval [CI] 0.24-0.72; P=0.002). After PS matching, the incidence of the primary outcome remained lower in the DAPT group (HR 0.36; 95% CI 0.19-0.71; P=0.003). The benefit of prolonged DAPT was consistent across subgroups.
Conclusions:
In CABG patients with high inflammatory risk, prolonged DAPT (≥12 months) was associated with significantly lower rates of all-cause death or MI compared with SAPT.
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