Dual antiplatelet therapy before coronary artery bypass grafting in patients with myocardial infarction: a prospective cohort study

• Published in: BMC surgery Vol. 21; no. 1; p. 449
• Main Authors: Sadeghi, Roxana, Haji Aghajani, Mohammad, Miri, Reza, Kachoueian, Naser, Jadbabaei, Amir Nasser, Mahjoob, Mohammad Parsa, Omidi, Fatemeh, Ghazanfarabadi, Mahboobeh, Sarveazad, Arash
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 31.12.2021; BioMed Central; BMC
• Subjects: Acute coronary syndrome; Acute coronary syndromes; Age; Analysis; Angiography; Anticoagulants; Antiplatelet therapy; Aspirin; Blood; Blood transfusions; Bypass; Cardiac patients; Care and treatment; Chest tubes; Clopidogrel; Cohort analysis; Coronary artery; Coronary Artery Bypass; Coronary vessels; Drug dosages; Drug Therapy, Combination; Dual anti-platelet therapy; Grafting; Health aspects; Heart attack; Heart attacks; Heart surgery; Hemoglobin; Hospital costs; Hospitalization; Humans; Ischemia; Length of stay; Medical imaging; Medical research; Medicine, Experimental; Mortality; Myocardial infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - epidemiology; Patients; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - therapeutic use; Postoperative period; Prospective Studies; Pulmonary arteries; Surgery; Therapy; Treatment Outcome; Veins & arteries; Clopidogrel; Aspirin; Coronary artery bypass; Acute coronary syndrome; Dual anti-platelet therapy
• ISSN: 1471-2482; 1471-2482
• 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.