Greater Los Angeles VA Medical Center, Los Angeles, California.
The Michael E. DeBakey VA Medical Center, Houston, Texas; Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2014 Jan;97(1):15-21. doi: 10.1016/j.athoracsur.2013.08.058. Epub 2013 Nov 6.
Clopidogrel use post coronary artery bypass grafting (CABG) has become more popular under the assumption that it improves graft patency. The purpose of this sub-analysis from the Randomized On and Off-Pump Bypass (ROOBY) trial is to evaluate the role of clopidogrel use post CABG to improve graft patency when added to standard aspirin therapy.
The ROOBY trial was a multi-center, randomized, controlled clinical trial that compared on-pump versus off-pump coronary artery bypass grafting (CABG). Clopidogrel use post CABG was left at the discretion of the operator. Detailed data regarding the use and timing of clopidogrel post CABG were collected prospectively, along with 1-year angiograms to evaluate graft status.
Of the 2,203 subjects undergoing CABG, 953 patient records had complete clopidogrel use and 1-year angiographic data. Of these, 345 (36.2%) received clopidogrel post CABG prior to discharge. Compared with patients with no post-CABG clopidogrel use, baseline characteristics were similar for the clopidogrel group except for the following: lower preoperative aspirin use (80.2% vs 86.7%, p = 0.009); higher preoperative clopidogrel use (23.5% vs 14.0%, p < 0.001), less on-pump (35.9% vs 55.9%, p < 0.0001); and lower endoscopic vein harvesting (30.8% vs 42.5%, p < 0.001) rates. Overall 1-year graft patency rates were not different between the clopidogrel and no-clopidogrel groups (86.5% vs 85.3%, p = 0.43). Multivariable analyses did not alter these findings.
This study suggests that routine post-CABG clopidogrel use may not translate to improved 1-year graft patency. Future studies appear warranted to better define the role of more aggressive antiplatelet therapy post CABG on graft patency and clinical outcomes.
在假设氯吡格雷可改善桥血管通畅性的情况下，经皮冠状动脉旁路移植术后（CABG）使用氯吡格雷的情况越来越普遍。ROOBY 试验的这项亚分析旨在评估 CABG 后使用氯吡格雷联合标准阿司匹林治疗对改善桥血管通畅性的作用。
ROOBY 试验是一项多中心、随机、对照临床试验，比较了体外循环下与非体外循环下的冠状动脉旁路移植术（CABG）。CABG 后氯吡格雷的使用由术者自行决定。前瞻性收集了详细的 CABG 后氯吡格雷使用和时间的数据，以及 1 年的血管造影以评估桥血管状态。
在 2203 例接受 CABG 的患者中，953 例患者的记录中有完整的氯吡格雷使用和 1 年的血管造影数据。其中，345 例（36.2%）在 CABG 后出院前接受了氯吡格雷治疗。与未使用 CABG 后氯吡格雷的患者相比，氯吡格雷组的基线特征除以下几点外相似：术前阿司匹林使用率较低（80.2% vs 86.7%，p = 0.009）；术前氯吡格雷使用率较高（23.5% vs 14.0%，p < 0.001）、非体外循环率较低（35.9% vs 55.9%，p < 0.0001）和内镜下静脉采集率较低（30.8% vs 42.5%，p < 0.001）。氯吡格雷组和无氯吡格雷组的 1 年桥血管通畅率总体上无差异（86.5% vs 85.3%，p = 0.43）。多变量分析也没有改变这些发现。
本研究表明，CABG 后常规使用氯吡格雷可能无法改善 1 年桥血管通畅率。似乎有必要进行进一步的研究，以更好地确定 CABG 后更积极的抗血小板治疗对桥血管通畅性和临床结局的作用。
