DAPT with clopidogrel and aspirin after CABG reduced the 6-month composite of death, MI, stroke, or repeat revascularization compared to aspirin alone (HR 0.65; 95% CI 0.55-0.77; P<0.001).
Cohort (n=18,069)
Does dual antiplatelet therapy with clopidogrel plus aspirin reduce the composite of all-cause death, myocardial infarction, stroke, or repeat revascularization in patients undergoing coronary artery bypass grafting compared to aspirin monotherapy?
In patients undergoing CABG, DAPT with clopidogrel and aspirin was associated with a significantly lower risk of major adverse cardiovascular and cerebrovascular events at 6 months compared to aspirin monotherapy, without a significant increase in major bleeding.
Effect estimate: HR 0.65 (95% CI 0.55-0.77)
Absolute Event Rate: 2.9% vs 4.2%
p-value: p=<0.001
Background The optimal antiplatelet therapy after coronary artery bypass grafting remains unclear. We evaluated the association of dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin and clinical outcomes among patients undergoing coronary artery bypass grafting. Methods and Results A total of 18 069 consecutive patients who underwent primary isolated coronary artery bypass grafting between 2013 and 2017 were identified from a contemporary registry, and 10 854 (60.1%) received DAPT with clopidogrel plus aspirin as determined by claimed prescriptions after surgery. Cox regression models with inverse probability of treatment weighting were used to examine the associations between DAPT and outcomes. Patients who received DAPT, compared with those who received aspirin monotherapy, had a lower incidence of a composite of all‐cause death, myocardial infarction, stroke, or repeat revascularization at 6 months (2.9% versus 4.2%; inverse probability of treatment weighting–adjusted hazard ratio HR, 0.65; 95% CI, 0.55–0.77; P <0.001) as well as death (HR, 0.61; 95% CI, 0.41–0.90), myocardial infarction (HR, 0.55; 95% CI, 0.40–0.74), and stroke (HR, 0.58; 95% CI, 0.46–0.74). The incidence of major bleeding did not differ significantly between the 2 groups (HR, 1.11; 95% CI, 0.69–1.78). Similar results were noted across multiple subgroups as well as when using different analytic methods. Conclusions Among patients undergoing coronary artery bypass grafting, DAPT with clopidogrel plus aspirin as secondary prevention was associated with reduced risk of major adverse cardiovascular and cerebrovascular events within 6 months as compared with aspirin monotherapy, and there was no significant increase in major bleeding.
Qu et al. (Sat,) conducted a cohort in Coronary artery bypass grafting (n=18,069). Dual antiplatelet therapy (clopidogrel plus aspirin) vs. Aspirin monotherapy was evaluated on Composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at 6 months (HR 0.65, 95% CI 0.55-0.77, p=<0.001). DAPT with clopidogrel and aspirin after CABG reduced the 6-month composite of death, MI, stroke, or repeat revascularization compared to aspirin alone (HR 0.65; 95% CI 0.55-0.77; P<0.001).