Dual Antiplatelet Therapy After Elective Coronary Artery Bypass Graft and Its Impact on Clinical Outcomes

Dual antiplatelet therapy (DAPT) has demonstrated survival benefits in patients undergoing coronary artery bypass grafting (CABG) for acute coronary syndrome. The impact of DAPT in patients undergoing elective CABG remains underexplored.

This single-center retrospective observational study reviewed all CABG procedures performed between 2012 and 2015. The primary outcome measured was the difference in mortality (all-cause and cardiovascular) between patients receiving aspirin monotherapy and those on DAPT. Secondary outcomes included post-CABG acute coronary syndrome, cerebrovascular accident, and major adverse cardiovascular events.

Among the 1828 patients who underwent elective CABG surgery, those who received DAPT had lower rates of all-cause mortality (odds ratio [OR], 0.43; 95% CI, 0.28-0.66; P < .001) and cardiovascular mortality (OR, 0.30; 95% CI, 0.16-0.56; P < .001) than aspirin monotherapy recipients. The overall survival rates were 93% and 97% for the aspirin monotherapy and DAPT groups, respectively (P < .001). The groups showed similar incidences of post-CABG acute coronary syndrome (OR, 1.14; 95% CI, 0.71-1.85; P = .629), post-CABG cerebrovascular accident (OR, 0.80; 95% CI, 0.45-1.43; P = .457), and major adverse cardiovascular events (OR, 0.73; 95% CI, 0.52-1.01; P = .061). Although DAPT patients experienced a higher rate of in-hospital major bleeding than aspirin monotherapy patients (OR, 1.48, 95% CI, 1.22-1.79; P < .001), the transfusion requirement was similar between the 2 groups (OR, 1.06, 95% CI, 0.77-1.46; P = .710).

The use of DAPT in elective CABG patients was associated with significantly higher survival rates and reduced incidences of all-cause and cardiovascular mortality than aspirin monotherapy.