Department of Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, The People's Republic of China.
J Am Coll Cardiol. 2010 Nov 9;56(20):1639-43. doi: 10.1016/j.jacc.2010.03.104.
We sought to evaluate the effect of aspirin plus clopidogrel versus aspirin alone on saphenous vein graft occlusion at 3 months after coronary artery bypass grafting (CABG).
Prevalence of graft occlusion is high after CABG. Aggressive antiplatelet therapy is expected to improve early post-operative graft patency.
From December 2007 through December 2008, 249 consecutive patients undergoing elective CABG at Fuwai Hospital were randomly assigned to 2 groups: 124 received aspirin (100 mg) plus clopidogrel (75 mg) daily (AC group), and 125 received aspirin (100 mg) alone daily (A group). Antiplatelet therapies were initiated when post-operative chest tube drainage was ≤ 30 cc/h for 2 h. All participants were invited for clinical follow-up and 64-slice multislice computed tomography angiography (MSCTA) analysis at 3 months post-operatively. Generalized estimating equations analysis was used to determine predictors of graft patency.
One participant, from group A, died before 3-month follow-up. Of the remaining 248 patients, 224 (90.3%) underwent MSCTA. Participants had similar pre-operative and intraoperative characteristics at baseline. No significant differences were observed in intraoperative transit-time flow measurement findings or major adverse cardiac-related events. Three-month MSCTA follow-up revealed that saphenous vein graft patency was 91.6% (219 of 239) in the AC group versus 85.7% (198 of 231) in the A group (p = 0.043). In multivariate analysis, combined antiplatelet therapy independently increased venous graft patency (p = 0.045).
Aspirin plus clopidogrel is more effective in venous graft patency than aspirin alone in the short term after CABG, but further, long-term study is needed. (The Clopidogrel and Aspirin After Surgery for Coronary Artery Disease; NCT00776477).
我们旨在评估与阿司匹林单药治疗相比，阿司匹林联合氯吡格雷对冠状动脉旁路移植术后 3 个月时大隐静脉桥闭塞的影响。
冠状动脉旁路移植术后桥血管闭塞的发生率较高。强化抗血小板治疗有望改善术后早期桥血管通畅率。
2007 年 12 月至 2008 年 12 月，249 例在阜外医院择期行冠状动脉旁路移植术的患者连续入选，随机分为两组：124 例患者接受每日阿司匹林（100 mg）联合氯吡格雷（75 mg）治疗（AC 组），125 例患者接受每日阿司匹林（100 mg）单药治疗（A 组）。当术后胸腔引流每小时≤30 cc 且持续 2 h 时开始应用抗血小板治疗。所有患者均受邀在术后 3 个月进行临床随访和 64 排多层螺旋 CT 血管造影（MSCTA）分析。采用广义估计方程分析确定桥血管通畅的预测因素。
A 组 1 例患者在 3 个月随访前死亡。在其余 248 例患者中，224 例（90.3%）完成了 MSCTA 检查。两组患者术前和术中基线特征相似。术中瞬时血流测量结果或主要心脏不良事件无显著差异。3 个月 MSCTA 随访显示，AC 组大隐静脉桥血管通畅率为 91.6%（219/239），A 组为 85.7%（198/231）（p=0.043）。多变量分析显示，联合抗血小板治疗可独立增加静脉桥血管通畅率（p=0.045）。
与阿司匹林单药治疗相比，阿司匹林联合氯吡格雷在冠状动脉旁路移植术后短期内更能提高静脉桥血管通畅率，但仍需要进一步的长期研究。（氯吡格雷和阿司匹林治疗冠状动脉疾病术后；NCT00776477）。
