Key result
Indobufen-based therapy shows no benefit over aspirin for 24-month MACCE after post-CABG unstable angina.
Why the study?
Postoperative antiplatelet selection after CABG in adults aged ≥70 years requires balancing ischemic protection against bleeding risk.
Does an initial indobufen-based discharge pathway reduce MACCE or bleeding compared to an aspirin-based pathway in adults aged 70 years and older undergoing isolated CABG for unstable angina?
Cohort (n=79)
No
Does an initial indobufen-based discharge pathway reduce MACCE or bleeding compared to an aspirin-based pathway in adults aged 70 years and older undergoing isolated CABG for unstable angina?
Hazard Ratio: 0.858 (95% CI 0.257–2.866)
p-value: p=0.803
In older adults undergoing CABG for unstable angina, an indobufen-based antiplatelet pathway showed no significant difference in 24-month ischemic or bleeding outcomes compared to standard aspirin, providing exploratory evidence for its use as a tolerable alternative.
Should not yet change aspirin-based regimens in older post-CABG patients; leaves open indobufen as an alternative pending prospective trials.
Background: Postoperative antiplatelet selection after coronary artery bypass grafting (CABG) in adults aged ≥70 years requires balancing ischemic protection against bleeding risk. Methods: We conducted a single-center retrospective cohort study of adults aged ≥70 years who underwent isolated CABG for unstable angina between 2017 and 2021. The exposure was the initial discharge antiplatelet pathway: aspirin 100 mg once daily or indobufen 100 mg twice daily as the cyclooxygenase-inhibitor component, combined with a P2Y12 inhibitor during the first postoperative year and followed by the same cyclooxygenase inhibitor during the second year. Propensity scores were estimated using multivariable logistic regression with 16 prespecified baseline covariates, and stabilized inverse probability of treatment weighting (IPTW) was applied. The primary analyses used IPTW-weighted Cox models. Results: Among 336 screened patients, 79 were included in the final analytic cohort (aspirin-based pathway, n = 49; indobufen-based pathway, n = 30). After weighting, measured covariate balance improved, although residual imbalance remained for prior myocardial infarction and prior percutaneous coronary intervention. At 24 months, no statistically significant association was observed between pathway and MACCE (HR 0.858, 95% CI 0.257–2.866; p = 0.803), BARC grade ≥2 bleeding (HR 0.359, 95% CI 0.093–1.385; p = 0.137), or NACE (HR 0.526, 95% CI 0.204–1.360; p = 0.185). Graft surveillance was evaluable in 77/79 patients at 1 year and 71/79 at 2 years and was analyzed descriptively. Conclusions: In this real-world cohort of older patients undergoing CABG for unstable angina, an initial indobufen-based discharge pathway was not statistically significantly associated with 24-month MACCE, BARC grade ≥2 bleeding, or NACE compared with an aspirin-based pathway after stabilized IPTW. These findings add exploratory CABG-specific data on indobufen in older patients and should be confirmed in larger prospective studies.
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Huang et al. (2026) conducted a cohort in Unstable angina after isolated coronary artery bypass grafting (CABG) (n=79). Indobufen-based discharge pathway vs. Aspirin-based discharge pathway was evaluated on 24-month major adverse cardiovascular and cerebrovascular events (MACCE) (HR 0.858, 95% CI 0.257–2.866, p=0.803). An initial indobufen-based discharge pathway was not significantly associated with 24-month MACCE compared with an aspirin-based pathway in older adults after CABG for unstable angina (HR 0.858).
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