Mangano Dennis T
Ischemia Research and Education Foundation, San Francisco, CA 94134, USA.
N Engl J Med. 2002 Oct 24;347(17):1309-17. doi: 10.1056/NEJMoa020798.
There is no therapy known to reduce the risk of complications or death after coronary bypass surgery. Because platelet activation constitutes a pivotal mechanism for injury in patients with atherosclerosis, we assessed whether early treatment with aspirin could improve survival after coronary bypass surgery.
At 70 centers in 17 countries, we prospectively studied 5065 patients undergoing coronary bypass surgery, of whom 5022 survived the first 48 hours after surgery. We gathered data on 7500 variables per patient and adjudicated outcomes centrally. The primary focus was to discern the relation between early aspirin use and fatal and nonfatal outcomes.
During hospitalization, 164 patients died (3.2 percent), and 812 others (16.0 percent) had nonfatal cardiac, cerebral, renal, or gastrointestinal ischemic complications. Among patients who received aspirin (up to 650 mg) within 48 hours after revascularization, subsequent mortality was 1.3 percent (40 of 2999 patients), as compared with 4.0 percent among those who did not receive aspirin during this period (81 of 2023, P<0.001). Aspirin therapy was associated with a 48 percent reduction in the incidence of myocardial infarction (2.8 percent vs. 5.4 percent, P<0.001), a 50 percent reduction in the incidence of stroke (1.3 percent vs. 2.6 percent, P=0.01), a 74 percent reduction in the incidence of renal failure (0.9 percent vs. 3.4 percent, P<0.001), and a 62 percent reduction in the incidence of bowel infarction (0.3 percent vs. 0.8 percent, P=0.01). Multivariate analysis showed that no other factor or medication was independently associated with reduced rates of these outcomes and that the risk of hemorrhage, gastritis, infection, or impaired wound healing was not increased with aspirin use (odds ratio for these adverse events, 0.63; 95 percent confidence interval, 0.54 to 0.74).
Early use of aspirin after coronary bypass surgery is safe and is associated with a reduced risk of death and ischemic complications involving the heart, brain, kidneys, and gastrointestinal tract.
目前尚无已知疗法可降低冠状动脉搭桥手术后并发症或死亡风险。由于血小板活化是动脉粥样硬化患者损伤的关键机制，我们评估了冠状动脉搭桥手术后早期使用阿司匹林是否能提高生存率。
在17个国家的70个中心，我们对5065例接受冠状动脉搭桥手术的患者进行了前瞻性研究，其中5022例在术后最初48小时内存活。我们收集了每位患者7500个变量的数据，并集中判定结果。主要重点是辨别早期使用阿司匹林与致命和非致命结果之间的关系。
住院期间，164例患者死亡（3.2%），另有812例（16.0%）出现非致命性心脏、脑、肾或胃肠道缺血并发症。在血管重建后48小时内接受阿司匹林（剂量高达650毫克）治疗的患者中，随后的死亡率为1.3%（2999例患者中的40例），而在此期间未接受阿司匹林治疗的患者死亡率为4.0%（2023例中的81例，P<0.001）。阿司匹林治疗使心肌梗死发生率降低48%（2.8%对5.4%，P<0.001），中风发生率降低50%（1.3%对2.6%，P=0.01），肾衰竭发生率降低74%（0.9%对3.4%，P<0.001），肠梗死发生率降低62%（0.3%对0.8%，P=0.01）。多变量分析表明，没有其他因素或药物与这些结果发生率的降低独立相关，且使用阿司匹林不会增加出血、胃炎、感染或伤口愈合受损的风险（这些不良事件的比值比为0.63；95%置信区间为0.54至0.74）。
冠状动脉搭桥手术后早期使用阿司匹林是安全的，且与心脏、脑、肾和胃肠道死亡及缺血并发症风险降低相关。
