Perioperative aspirin and long-term survival in patients undergoing coronary artery bypass graft

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Coronary Artery Bypass Graft (CABG) (n=4132). Intervention: Preoperative aspirin vs. No preoperative aspirin. Primary outcome: 4-year mortality (RR 0.82, 95% CI 0.75-0.89, p=0.005).

Qian Ding; Hong Liu; Zugui Zhang; Jordan E. Goldhammer; Eric Yuen; Zhongmin Li; Linong Yao; Nilas Young; Douglas Boyd; William S. Weintraub; Rohinton J. Morris; Jianzhong Sun

doi:10.1038/s41598-018-35208-7

November 13, 2018The Medicine ForumOpen Access

Perioperative aspirin and long-term survival in patients undergoing coronary artery bypass graft

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Key result

Preoperative aspirin linked to ~18% lower 4-year mortality in CABG patients.

RR 0.82
95% CI 0.75-0.89
P=0.005
n=4,132

Figures

Why the study?

Does perioperative aspirin reduce 30-day and long-term mortality in patients undergoing CABG?

Key Points

To examine the association between the use of aspirin perioperatively and long-term survival in patients undergoing coronary artery bypass graft (CABG).
Retrospective cohort study of 4,132 CABG patients from three tertiary hospitals.
Patients categorized into four groups based on preoperative and postoperative aspirin use.
Propensity scores and inverse probability weighting used to adjust for treatment-selection bias.
Preoperative aspirin associated with reduced risk of 30-day mortality.
Postoperative aspirin linked to 4-year mortality reduction (10.7% vs. 16.2%, RR: 0.66, 95% CI: 0.50–0.82, P = 0.003).
Preoperative aspirin reduced 30-day mortality without significant bleeding complications.

Study Design

Type

Cohort (n=4,132)

Multicenter

Yes

Structured PICO

Does perioperative aspirin reduce 30-day and long-term mortality in patients undergoing CABG?

P

Population

4,132 patients undergoing CABG with or without valve surgery from three tertiary hospitals in the United States. Mean age 66.3, 79% male (in preoperative aspirin group).

I

Intervention

Preoperative aspirin (within 5 days preceding surgery) and postoperative aspirin (on discharge)

C

Comparator

No preoperative aspirin and no postoperative aspirin

O

Outcome

30-day and long-term (4-year) all-cause mortalityhard clinical

Main Result

Effect estimate: RR 0.82 (95% CI 0.75-0.89)

Absolute Event Rate: 14.8% vs 18.1%

p-value: p=0.005

Perioperative use of aspirin in patients undergoing CABG is associated with a significant reduction in 30-day and 4-year mortality without increasing bleeding complications.

Limitations

Non-randomized study design with potential for unmeasured confounding factors
Potential immortal time bias when classifying patients into continuation versus no aspirin groups
Lack of data on the specific dose and adherence of aspirin
Potential flaws of a non-randomized study
Unknown confounding factors
Immortal time bias due to timespan between pre- and post-operative aspirin
Lack of data on dose and adherence of aspirin

Implication

Preoperative aspirin was associated with lower 4-year CABG mortality; leaves open whether RCTs should test perioperative strategies.

Abstract

This study aimed to examine association between perioperative uses of aspirin and long-term survival in patients undergoing CABG. A retrospective cohort study was performed in 9,584 consecutive patients receiving cardiac surgery from three tertiary hospitals. Of all the patients, 4,132 patients undergoing CABG met inclusion criteria and were divided into four groups: with or without preoperative or postoperative aspirin respectively. 30-day postoperative and long-term mortality were compared with the use of propensity scores and inverse probability weighting adjustment to reduce the treatment-selection bias. The patients taking preoperative aspirin presented significantly more with comorbidities. However, the results of this study showed that preoperative aspirin (vs. no preoperative aspirin) was associated with significantly reduced the risk of 30-day mortality in the patients undergoing CABG. Further, the results of long-term mortality showed that the patients taking preoperative aspirin and postoperative aspirin (vs. not taking) were associated with significantly reduced the risk of 4-year mortality (14.8% vs. 18.1%, RR: 0.82, 95% CI: 0.75–0.89, P = 0.005; 10.7% vs. 16.2%, RR: 0.66, 95% CI: 0.50–0.82, P = 0.003). In conclusion, this cohort study showed that perioperative (before and after surgery) use of aspirin was associated with significant reduction in 30-day mortality without significant bleeding complications, also improved long-term survival in patients undergoing CABG.

Discussion

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Cite This Study

Ding et al. (2018) conducted a cohort in Coronary Artery Bypass Graft (CABG) (n=4,132). Preoperative aspirin vs. No preoperative aspirin was evaluated on 4-year mortality (RR 0.82, 95% CI 0.75-0.89, p=0.005). Preoperative aspirin significantly reduced the risk of 4-year mortality compared to no preoperative aspirin (14.8% vs. 18.1%, RR 0.82) in patients undergoing coronary artery bypass graft surgery.

synapsesocial.com/papers/6a0766c86b3d000707586c6c https://doi.org/10.1038/s41598-018-35208-7

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Perioperative aspirin and long-term survival in patients undergoing coronary artery bypass graft

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Perioperative aspirin and long-term survival in patients undergoing coronary artery bypass graft

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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