López José, Morales Carlos, Avanzas Pablo, Callejo Francisco, Hernández-Vaquero Daniel, Llosa Juan C
Department of Cardiac Surgery, University Central Hospital of Asturias, Oviedo, Asturias, Spain.
J Card Surg. 2013 Jul;28(4):366-72. doi: 10.1111/jocs.12144.
Recent studies have found increased long-term cardiovascular morbidity after off-pump coronary artery bypass surgery (OPCAB). We evaluated the efficacy and safety of dual antiplatelet therapy (DAT) in the prevention of cardiovascular events at two years after OPCAB surgery.
Retrospective study that included all patients that underwent OPCAB surgery in our institution between 2009 and 2010. Single or dual antiplatelet therapy was initiated at hospital discharge, and its effect in patients' prognosis was analyzed. Follow-up was conducted by telephone and using the hospital databases. The primary end-point was the composite of acute coronary syndrome (ACS), revascularization, stroke, or cardiovascular death.
The study included 237 patients divided into: (A) 128 patients who received single antiplatelet therapy and (B) 109 patients who received dual antiplatelet therapy. The mean follow-up was 23.85 months (standard deviation 0.5 months). 13.9% of patients had a primary end-point event. Patients in group A had a higher event rate compared with group B (18.8% vs. 8.3%, p = 0.02), with a significant reduction in hospital readmissions for ACS (10.9% vs. 3.7%, p = 0.035). In the multivariate analysis, dual antiplatelet therapy was an independent protective factor in the occurrence of events (hazard ratio = 0.395, 95% CI, 0.176 to 0.885, p = 0.024). There were no significant differences between the two groups with respect to bleeding events.
Dual antiplatelet therapy after OPCAB surgery is associated with a decrease in the appearance of new cardiovascular events, due to a reduction in the number of hospital readmissions for ACS.
近期研究发现非体外循环冠状动脉搭桥手术（OPCAB）后长期心血管疾病发病率增加。我们评估了双联抗血小板治疗（DAT）在预防OPCAB手术后两年心血管事件中的疗效和安全性。
回顾性研究纳入了2009年至2010年在我院接受OPCAB手术的所有患者。出院时开始单药或双联抗血小板治疗，并分析其对患者预后的影响。通过电话和医院数据库进行随访。主要终点是急性冠状动脉综合征（ACS）、血运重建、中风或心血管死亡的复合终点。
该研究纳入237例患者，分为：（A）128例接受单药抗血小板治疗的患者和（B）109例接受双联抗血小板治疗的患者。平均随访时间为23.85个月（标准差0.5个月）。13.9%的患者发生了主要终点事件。A组患者的事件发生率高于B组（18.8%对8.3%，p = 0.02），ACS再入院率显著降低（10.9%对3.7%，p = 0.035）。在多变量分析中，双联抗血小板治疗是事件发生的独立保护因素（风险比 = 0.395，95%CI，0.176至0.885，p = 0.024）。两组在出血事件方面无显著差异。
OPCAB手术后的双联抗血小板治疗与新的心血管事件发生率降低相关，这是由于ACS再入院次数减少所致。
