Key result
Early antiplatelet therapy within 24 hours post-CABG linked to ~39% lower 30-day mortality.
Why the study?
The effect of early antiplatelet therapy on 30-day mortality after CABG remains uncertain.
Does early antiplatelet therapy initiated within 24 hours postoperatively reduce 30-day mortality in adult patients who underwent CABG?
Observational (n=6,887)
No
Does early antiplatelet therapy initiated within 24 hours postoperatively reduce 30-day mortality in adult patients who underwent CABG?
Effect estimate: Absolute risk difference 0.90% (95% CI 0.09% to 1.72%)
Absolute Event Rate: 1.44% vs 2.35%
Early initiation of antiplatelet therapy within 24 hours after CABG is associated with significantly lower 30-day mortality and a reduced incidence of postoperative AKI.
Early antiplatelet post-CABG should not change practice; leaves open mortality benefit for confirmatory RCTs.[[1]](https://bmjopen.bmj.
Objectives The effect of early antiplatelet therapy on 30-day mortality after coronary artery bypass grafting (CABG) remains uncertain. This study aimed to evaluate the association between early antiplatelet therapy initiation and clinical outcomes in post-CABG patients. Design A retrospective target trial emulation. Setting Single academic medical centre in Boston, Massachusetts, USA. Participants We included adult patients who underwent CABG and were admitted to the intensive care unit at Beth Israel Deaconess Medical Center between 2008 and 2022. Methods Patients were classified into the treatment group if they initiated antiplatelet therapy within 24 hours postoperatively; otherwise, they were assigned to the control group. To address immortal-time bias for the primary outcome of 30-day mortality, we used clone-censor-weighting. For the exploratory outcome of 30-day acute kidney injury (AKI) incidence, we employed inverse probability of treatment weighting to balance baseline covariates. Results The analysis for 30-day mortality included 6887 patients. The mortality was 2.35% in the control group versus 1.44% in the treatment group, yielding an absolute risk difference of 0.90% (control group minus treatment group, 95% CI 0.09% to 1.72%). The difference in restricted mean time lost was 0.19 days (control group minus treatment group, 95% CI 0.03 to 0.36). For AKI incidence, 5543 patients were analysed. The incidence was 78.61% in the control group and 69.13% in the treatment group, with an absolute difference of 9.48% (control group minus treatment group, 95% CI 6.40% to 12.50%; p<0.001). Conclusions In this target trial emulation, early antiplatelet therapy initiated within 24 hours after CABG was associated with lower 30-day mortality and a reduced incidence of postoperative AKI. These findings warrant confirmation in prospective randomised controlled trials.
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Jiang et al. (2026) conducted an observational in Coronary artery bypass grafting (CABG) (n=6,887). Early antiplatelet therapy (within 24 hours postoperatively) vs. No early antiplatelet therapy (after 24 hours or none) was evaluated on 30-day mortality (Absolute risk difference 0.90%, 95% CI 0.09% to 1.72%). Early antiplatelet therapy initiated within 24 hours after CABG was associated with lower 30-day mortality (1.44% vs 2.35%; absolute risk difference 0.90%, 95% CI 0.09% to 1.72%).
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