Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Cardiac Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Surg. 2021 Dec 31;21(1):449. doi: 10.1186/s12893-021-01436-4.
Dual antiplatelet therapy (DAPT) in patients with MI who are candidates for early coronary artery bypass grafting (CABG) can affect intraoperative and postoperative outcomes. Therefore, the aim of this study was to evaluate the effect of DAPT up to the day before CABG on the outcomes during and after surgery in patients with MI.
In this prospective cohort study, 224 CABG candidate patients with and without MI were divided into two groups: (A) patients without MI who were treated with aspirin 80 mg/day before surgery (noMI-aspirin group; n = 124) and (B) patients with MI who were treated with aspirin 80 mg/day before surgery and clopidogrel (Plavix brand) at a dose of 75 mg/day (MI-DAPT group; n = 120). Dual or mono-antiplatelet therapy continued until the day before surgery. Patients were followed to assess in-hospital and 6-months outcomes.
The in-hospital mortality in MI-DAPT group was similar with noMI-aspirin group (OR 4.2; 95% CI 0.9-20.5; p = 0.071). The prevalence of CVA (p = 0.098), duration of hospital stay (p = 0.109), postoperative ejection fraction level (p = 0.693), diastolic dysfunction grade (p = 0.651) and postoperative PAP level (p = 0.0364) did not show difference between two groups. No mild or severe bleeding was observed in the patients. Six-month follow up showed that number of readmissions (p = 0.801), number of cases requiring angiography (p = 0.100), cases requiring re-PCI (p = 0.156), need for re-CABG (p > 0.999) and CVA (p > 0.999) did not differ between the two groups. During the 6-month follow-up, out-hospital mortality did not differ significantly between the two groups (p = 0.446).
A 6-month follow-up showed that DAPT with aspirin and clopidogrel before CABG in patients with MI has no effect on postoperative outcomes more than mono-APT with aspirin. Therefore, DAPT is recommended in the preoperative period for these patients.
对于适合早期冠状动脉旁路移植术（CABG）的心肌梗死（MI）患者，双联抗血小板治疗（DAPT）可能会影响术中及术后结果。因此，本研究旨在评估 MI 患者在 CABG 前一天停止 DAPT 对 MI 患者手术期间和术后结局的影响。
在这项前瞻性队列研究中，将 224 例 CABG 候选患者分为 MI 组和非 MI 组：（A）非 MI 患者，术前接受阿司匹林 80mg/天治疗（无 MI-阿司匹林组；n=124）；（B）MI 患者，术前接受阿司匹林 80mg/天和氯吡格雷（Plavix 品牌）75mg/天治疗（MI-DAPT 组；n=120）。双抗或单抗血小板治疗持续至术前一天。对患者进行随访，以评估住院期间和 6 个月的结局。
MI-DAPT 组住院死亡率与无 MI-阿司匹林组相似（比值比 4.2；95%置信区间 0.9-20.5；p=0.071）。两组间 CVA（p=0.098）、住院时间（p=0.109）、术后射血分数水平（p=0.693）、舒张功能障碍分级（p=0.651）和术后 PAP 水平（p=0.0364）差异均无统计学意义。两组患者均未发生轻度或重度出血。6 个月随访显示，再入院人数（p=0.801）、需要行血管造影人数（p=0.100）、需要再次经皮冠状动脉介入治疗（p=0.156）、需要再次 CABG 人数（p＞0.999）和 CVA 人数（p＞0.999）均无差异。6 个月随访期间，两组间院外死亡率无显著差异（p=0.446）。
6 个月随访结果显示，MI 患者 CABG 前使用阿司匹林和氯吡格雷进行 DAPT 治疗与单独使用阿司匹林进行单抗治疗相比，对术后结局无影响。因此，建议对这些患者在术前进行 DAPT。
