Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART)
<p><strong>Objectives:</strong> There is still little evidence to support routine dual antiplatelet therapy (DAPT) with P2Y12 antagonists following coronary artery bypass grafting (CABG). The Arterial Re-vascularization Trial (ART) was designed to compare 10-year survival after bil...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Oxford University Press
2017
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| _version_ | 1797055252984233984 |
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| author | Benedetto, U Altman, D Gerry, S Gray, A Lees, B Flather, M Taggart, D |
| author_facet | Benedetto, U Altman, D Gerry, S Gray, A Lees, B Flather, M Taggart, D |
| author_sort | Benedetto, U |
| collection | OXFORD |
| description | <p><strong>Objectives:</strong> There is still little evidence to support routine dual antiplatelet therapy (DAPT) with P2Y12 antagonists following coronary artery bypass grafting (CABG). The Arterial Re-vascularization Trial (ART) was designed to compare 10-year survival after bilateral versus single internal thoracic artery grafting. We aimed to get insights into the effect of DAPT (with clopidogrel) following CABG on 1 year outcomes by performing a post-hoc ART anal-ysis.</p> <p><strong>Methods:</strong> Among patients enrolled in the ART (n=3102), 609 (21%) and 2308 (79%) were discharged on DAPT or aspirin alone respectively. The primary endpoint was the incidence of major adverse cerebrovascular and cardiac events (MACCE) at 1 year including cardiac death, myocardial infarction, cerebrovascular accident and reintervention; safety endpoint was bleeding requiring hospitalization. Propensity score (PS) matching was used to create comparable groups.</p> <p><strong>Results:</strong> Among 609-PS matched pairs, MACCE occurred in 34 (5.6%) and 34 (5.6%) in the DAPT and aspirin alone groups respectively with no significant difference between the two groups (HR 0.97; 95%CI 0.59-1.59; P=0.90). Only 188 (31%) subjects completed 1 year of DAPT and in this subgroup, MACCE rate was 5.8% (HR 1.11; 95%CI 0.53-2.30; P=0.78). In the overall sample, bleeding rate was higher in DAPT group (2.3% versus 1.1%; P=0.02) although this difference was no longer significant after matching (2.3% vs 1.8%; P=0.54).</p> <p><strong>Conclusions:</strong> Based on these findings, when compared to aspirin alone, DAPT with clopidogrel prescribed at discharge was not associated with a significant reduction of adverse cardiac and cerebrovascular events at 1 year following CABG.</p> |
| first_indexed | 2024-03-06T19:08:03Z |
| format | Journal article |
| id | oxford-uuid:15d491a1-8fc5-43f9-8cfc-dc0f9581ad5c |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T19:08:03Z |
| publishDate | 2017 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:15d491a1-8fc5-43f9-8cfc-dc0f9581ad5c2022-03-26T10:27:44ZImpact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART)Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:15d491a1-8fc5-43f9-8cfc-dc0f9581ad5cEnglishSymplectic Elements at OxfordOxford University Press2017Benedetto, UAltman, DGerry, SGray, ALees, BFlather, MTaggart, D<p><strong>Objectives:</strong> There is still little evidence to support routine dual antiplatelet therapy (DAPT) with P2Y12 antagonists following coronary artery bypass grafting (CABG). The Arterial Re-vascularization Trial (ART) was designed to compare 10-year survival after bilateral versus single internal thoracic artery grafting. We aimed to get insights into the effect of DAPT (with clopidogrel) following CABG on 1 year outcomes by performing a post-hoc ART anal-ysis.</p> <p><strong>Methods:</strong> Among patients enrolled in the ART (n=3102), 609 (21%) and 2308 (79%) were discharged on DAPT or aspirin alone respectively. The primary endpoint was the incidence of major adverse cerebrovascular and cardiac events (MACCE) at 1 year including cardiac death, myocardial infarction, cerebrovascular accident and reintervention; safety endpoint was bleeding requiring hospitalization. Propensity score (PS) matching was used to create comparable groups.</p> <p><strong>Results:</strong> Among 609-PS matched pairs, MACCE occurred in 34 (5.6%) and 34 (5.6%) in the DAPT and aspirin alone groups respectively with no significant difference between the two groups (HR 0.97; 95%CI 0.59-1.59; P=0.90). Only 188 (31%) subjects completed 1 year of DAPT and in this subgroup, MACCE rate was 5.8% (HR 1.11; 95%CI 0.53-2.30; P=0.78). In the overall sample, bleeding rate was higher in DAPT group (2.3% versus 1.1%; P=0.02) although this difference was no longer significant after matching (2.3% vs 1.8%; P=0.54).</p> <p><strong>Conclusions:</strong> Based on these findings, when compared to aspirin alone, DAPT with clopidogrel prescribed at discharge was not associated with a significant reduction of adverse cardiac and cerebrovascular events at 1 year following CABG.</p> |
| spellingShingle | Benedetto, U Altman, D Gerry, S Gray, A Lees, B Flather, M Taggart, D Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART) |
| title | Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART) |
| title_full | Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART) |
| title_fullStr | Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART) |
| title_full_unstemmed | Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART) |
| title_short | Impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the Arterial Revascularization Trial (ART) |
| title_sort | impact of dual antiplatelet therapy after coronary artery bypass surgery on 1 year outcomes in the arterial revascularization trial art |
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