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Published on: March 27, 2018
Effect of early antiplatelet therapy on 30-day mortality after coronary artery bypass grafting: a retrospective
Ying Jiang1, Huafeng Ding2, Jing Su2
1Xuzhou Hospital of Traditional Chinese Medicine, Xuzhou, Jiangsu, China.
Insights
Early antiplatelet therapy after coronary artery bypass grafting (CABG) significantly reduced 30-day mortality and acute kidney injury (AKI). This finding suggests a potential benefit for early intervention in post-CABG care.
Area of Science:
- Cardiology
- Critical Care Medicine
- Surgical Outcomes
Background:
- Uncertainty exists regarding the impact of early antiplatelet therapy on outcomes following coronary artery bypass grafting (CABG).
- Assessing the association between early antiplatelet initiation and clinical outcomes in post-CABG patients is crucial for optimizing patient care.
Purpose of the Study:
- To evaluate the effect of initiating antiplatelet therapy within 24 hours post-CABG on 30-day mortality.
- To determine the association between early antiplatelet therapy and the incidence of postoperative acute kidney injury (AKI) within 30 days.
Main Methods:
- Retrospective target trial emulation using data from adult patients undergoing CABG between 2008 and 2022.
- Clone-censor-weighting method applied to address immortal-time bias for 30-day mortality analysis.
- Inverse probability of treatment weighting used to balance covariates for AKI incidence analysis.
Main Results:
- Early antiplatelet therapy (within 24 hours) was associated with a reduced 30-day mortality rate (1.44% vs. 2.35%).
- A significant decrease in the incidence of 30-day acute kidney injury (AKI) was observed with early antiplatelet therapy (69.13% vs. 78.61%).
- Absolute risk difference for mortality was 0.90% and for AKI was 9.48%.
Conclusions:
- Initiating antiplatelet therapy early (within 24 hours) after CABG is linked to lower 30-day mortality.
- Early antiplatelet therapy demonstrated a reduction in postoperative AKI incidence.
- Prospective randomized controlled trials are recommended to confirm these findings.
Objectives:
The effect of early antiplatelet therapy on 30-day mortality after coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate the association between early antiplatelet therapy initiation and clinical outcomes in post-CABG patients.
Design:
A retrospective target trial emulation.
Setting:
Single academic medical centre in Boston, Massachusetts, USA.
Participants:
We included adult patients who underwent CABG and were admitted to the intensive care unit at Beth Israel Deaconess Medical Center between 2008 and 2022.
Methods:
Patients were classified into the treatment group if they initiated antiplatelet therapy within 24 hours postoperatively; otherwise, they were assigned to the control group. To address immortal-time bias for the primary outcome of 30-day mortality, we used clone-censor-weighting. For the exploratory outcome of 30-day acute kidney injury (AKI) incidence, we employed inverse probability of treatment weighting to balance baseline covariates.
Results:
The analysis for 30-day mortality included 6887 patients. The mortality was 2.35% in the control group versus 1.44% in the treatment group, yielding an absolute risk difference of 0.90% (control group minus treatment group, 95% CI 0.09% to 1.72%). The difference in restricted mean time lost was 0.19 days (control group minus treatment group, 95% CI 0.03 to 0.36). For AKI incidence, 5543 patients were analysed. The incidence was 78.61% in the control group and 69.13% in the treatment group, with an absolute difference of 9.48% (control group minus treatment group, 95% CI 6.40% to 12.50%; p<0.001).
Conclusions:
In this target trial emulation, early antiplatelet therapy initiated within 24 hours after CABG was associated with lower 30-day mortality and a reduced incidence of postoperative AKI. These findings warrant confirmation in prospective randomised controlled trials.
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