Cookies on this website
We use cookies to ensure that we give you the best experience on our website. If you click 'Continue' we'll assume that you are happy to receive all cookies and you won't see this message again. Click 'Find out more' for information on how to change your cookie settings.

There is still little evidence to boldport routine dual antiplatelet therapy (DAPT) with P 2 Y 12 antagonists following coronary artery bypass grafting (CABG). The Arterial Revascularization Trial (ART) was designed to compare 10-year survival after bilateral versus single internal thoracic artery grafting. We aimed to get insights into the effect of DAPT (with clopidogrel) following CABG on 1-year outcomes by performing a post hoc ART analysis.Among patients enrolled in the ART ( n  = 3102), 609 (21%) and 2308 (79%) were discharged on DAPT or aspirin alone, respectively. The primary end-point was the incidence of major adverse cerebrovascular and cardiac events (MACCE) at 1 year including cardiac death, myocardial infarction, cerebrovascular accident and reintervention; safety end-point was bleeding requiring hospitalization. Propensity score (PS) matching was used to create comparable groups.Among 609 PS-matched pairs, MACCE occurred in 34 (5.6%) and 34 (5.6%) in the DAPT and aspirin alone groups, respectively, with no significant difference between the 2 groups [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.59-1.59; P  = 0.90]. Only 188 (31%) subjects completed 1 year of DAPT, and in this subgroup, MACCE rate was 5.8% (HR 1.11, 95% CI 0.53-2.30; P  = 0.78). In the overall sample, bleeding rate was higher in DAPT group (2.3% vs 1.1%; P  = 0.02), although this difference was no longer significant after matching (2.3% vs 1.8%; P  = 0.54).Based on these findings, when compared with aspirin alone, DAPT with clopidogrel prescribed at discharge was not associated with a significant reduction of adverse cardiac and cerebrovascular events at 1 year following CABG.

Original publication

DOI

10.1093/ejcts/ezx075

Type

Journal article

Journal

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

Publication Date

06/04/2017

Addresses

Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK.

Keywords

ART Investigators