Key result
Clopidogrel plus aspirin did not reduce the incidence of evolving or new lesions vs aspirin alone (70% vs 74%, P=0.8), but reduced new occlusions (7% vs 22%, P=0.02) 1 year post-CABG.
Why the study?
Does clopidogrel plus aspirin reduce the progression of native coronary artery disease in patients after coronary artery bypass grafting compared to aspirin alone?
RCT (n=92)
Placebo-controlled
Yes
Does clopidogrel plus aspirin reduce the progression of native coronary artery disease in patients after coronary artery bypass grafting compared to aspirin alone?
The addition of clopidogrel to aspirin for 1 year after CABG significantly reduces the angiographic severity of native coronary artery disease progression and the incidence of new occlusions compared to aspirin alone.
Clopidogrel plus aspirin does not reduce post-CABG lesion progression; challenges routine dual therapy while leaving open occlusion prevention in larger trials.
BACKGROUND: The effects of dual antiplatelet therapy with aspirin and clopidogrel on the progression of native coronary artery disease after coronary artery bypass grafting are unknown. METHODS AND RESULTS: In the Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) trial, a total of 113 patients were randomized to receive aspirin plus clopidogrel or aspirin plus placebo for 1 year after coronary artery bypass grafting. In this secondary analysis, the 92 patients who underwent preoperative and 1-year postoperative angiograms at 2 centers had each of their coronary stenoses graded serially by using 6 thresholds (grade 0 [0%-24%], grade 1 [25%-37%], grade 2 [38%-62%], grade 3 [63%-82%], grade 4 [83%-98%], and grade 5 [99%-100%]). We compared the incidence and degree of evolving coronary artery disease between the 2 treatment groups. A total of 543 preoperative stenoses and occlusions were quantified and followed. At 1-year postoperatively, there were 103 evolving (94 worsened, 9 improved) and 22 new lesions. The right coronary artery territory and sites proximal to a graft were more commonly associated with worsening coronary artery disease (P≤0.02). There were no differences in clinical events between treatment groups, and the proportion of patients with evolving or new lesions was also similar (70% versus 74%, aspirin-clopidogrel versus aspirin-placebo, respectively; P=0.8). However, in evolving or new lesions, the mean grade change (1.1±1.0 versus 1.6±1.1, respectively; P=0.01) and the proportion of new occlusions (7% versus 22%; P=0.02) were lower in the aspirin-clopidogrel group. CONCLUSIONS: The addition of clopidogrel to aspirin correlates with less worsening of native coronary artery disease 1 year after coronary artery bypass grafting. These findings may help guide post-coronary artery bypass grafting antiplatelet therapy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00228423.
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Une et al. (2014) conducted an RCT in Native coronary artery disease after bypass surgery (n=92). Clopidogrel plus aspirin vs. Aspirin plus placebo was evaluated on Proportion of patients with evolving or new lesions (p=0.8). Clopidogrel plus aspirin did not reduce the incidence of evolving or new lesions vs aspirin alone (70% vs 74%, P=0.8), but reduced new occlusions (7% vs 22%, P=0.02) 1 year post-CABG.
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