1. Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease.
- Author
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Daoulah A, Qenawi W, Alshehri A, Jameel Naser M, Elmahrouk Y, Alshehri M, Elmahrouk A, Qutub MA, Alzahrani B, Yousif N, Arafat AA, Almahmeed W, Elganady A, Dahdouh Z, Hersi AS, Jamjoom A, Alama MN, Selim E, Hashmani S, Hassan T, Alqahtani AM, Abohasan A, Ghani MA, Al Nasser FOM, Refaat W, Iskandar M, Haider O, Fathey Hussien A, Ghonim AA, Shawky AM, Abualnaja S, Kazim HM, Abdulhabeeb IAM, Alshali KZ, Aithal J, Altnji I, Amin H, Ibrahim AM, Al Garni T, Elkhereiji AA, Noor HA, Ahmad O, Alzahrani FJ, Alasmari A, Alkaluf A, Elghaysha E, Al Wabisi SO, Algublan AN, Nasim N, Alhamid S, Sait B, Alqahtani AH, Balghith M, Kanbr O, Abozenah M, and Lotfi A
- Subjects
- Humans, Platelet Aggregation Inhibitors therapeutic use, Retrospective Studies, Treatment Outcome, Coronary Artery Bypass adverse effects, Hemorrhage chemically induced, Acute Coronary Syndrome surgery, Acute Coronary Syndrome chemically induced, Coronary Artery Disease, Acute Kidney Injury chemically induced, Percutaneous Coronary Intervention
- Abstract
Background: The use of dual antiplatelet therapy (DAPT) after coronary revascularization for left-main disease is still debated. The study aimed to characterize patients who received dual versus single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients., Results: This multicenter retrospective cohort study included 551 patients who were grouped into 2 groups: patients who received SAPT (n = 150) and those who received DAPT (n = 401). There were no differences in age ( P = 0.451), gender ( P = 0.063), smoking ( P = 0.941), diabetes mellitus ( P = 0.773), history of myocardial infarction ( P = 0.709), chronic kidney disease ( P = 0.615), atrial fibrillation ( P = 0.306), or cerebrovascular accident ( P = 0.550) between patients who received SAPT versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [87 (58%) vs. 273 (68.08%); P = 0.027], after off-pump CABG [12 (8%) vs. 73 (18.2%); P = 0.003] and in patients with radial artery grafts [1 (0.67%) vs. 32 (7.98%); P < 0.001]. While SAPTs were more commonly used in patients with low ejection fraction [55 (36.67%) vs. 61 (15.21%); P < 0.001] and in patients with postoperative acute kidney injury [27 (18%) vs. 37 (9.23%); P = 0.004]. The attributed treatment effect of DAPT for follow-up major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, -2.08 (95% confidence interval (CI), -20.8-16.7); P = 0.828]. The attributed treatment effect of DAPT on follow-up all-cause mortality was not significantly different from that of SAPT [β, 4.12 (CI, -11.1-19.32); P = 0.595]. There was no difference in bleeding between groups ( P = 0.666)., Conclusions: DAPTs were more commonly used in patients with acute coronary syndrome, after off-pump CABG, and with radial artery grafts. SAPTs were more commonly used in patients with low ejection fraction and acute kidney injury. Patients on DAPT after CABG for left-main disease had comparable major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
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