Amin Daoulah, Wael Qenawi, Ali Alshehri, Maryam Jameel Naser, Youssef Elmahrouk, Mohammed Alshehri, Ahmed Elmahrouk, Mohammed A Qutub, Badr Alzahrani, Nooraldaem Yousif, Amr A Arafat, Wael Almahmeed, Abdelmaksoud Elganady, Ziad Dahdouh, Ahmad S Hersi, Ahmed Jamjoom, Mohamed N Alama, Ehab Selim, Shahrukh Hashmani, Taher Hassan, Abdulrahman M Alqahtani, Abdulwali Abohasan, Mohamed Ajaz Ghani, Faisal Omar M Al Nasser, Wael Refaat, Mina Iskandar, Omar Haider, Adnan Fathey Hussien, Ahmed A Ghonim, Abeer M Shawky, Seraj Abualnaja, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Khalid Z Alshali, Jairam Aithal, Issam Altnji, Haitham Amin, Ahmed M Ibrahim, Turki Al Garni, Abdulaziz A Elkhereiji, Husam A Noor, Osama Ahmad, Faisal J Alzahrani, Abdulaziz Alasmari, Abdulaziz Alkaluf, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Sameer Alhamid, Basim Sait, Abdulrahman H Alqahtani, Mohammed Balghith, Omar Kanbr, Mohammed Abozenah, Amir Lotfi
{"title":"Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease.","authors":"Amin Daoulah, Wael Qenawi, Ali Alshehri, Maryam Jameel Naser, Youssef Elmahrouk, Mohammed Alshehri, Ahmed Elmahrouk, Mohammed A Qutub, Badr Alzahrani, Nooraldaem Yousif, Amr A Arafat, Wael Almahmeed, Abdelmaksoud Elganady, Ziad Dahdouh, Ahmad S Hersi, Ahmed Jamjoom, Mohamed N Alama, Ehab Selim, Shahrukh Hashmani, Taher Hassan, Abdulrahman M Alqahtani, Abdulwali Abohasan, Mohamed Ajaz Ghani, Faisal Omar M Al Nasser, Wael Refaat, Mina Iskandar, Omar Haider, Adnan Fathey Hussien, Ahmed A Ghonim, Abeer M Shawky, Seraj Abualnaja, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Khalid Z Alshali, Jairam Aithal, Issam Altnji, Haitham Amin, Ahmed M Ibrahim, Turki Al Garni, Abdulaziz A Elkhereiji, Husam A Noor, Osama Ahmad, Faisal J Alzahrani, Abdulaziz Alasmari, Abdulaziz Alkaluf, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Sameer Alhamid, Basim Sait, Abdulrahman H Alqahtani, Mohammed Balghith, Omar Kanbr, Mohammed Abozenah, Amir Lotfi","doi":"10.1097/HPC.0000000000000342","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The use of dual antiplatelet therapy (DAPT) after coronary revascularization for left-main disease is still debated. The study aimed to characterize patients who received dual versus single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients.</p><p><strong>Results: </strong>This multicenter retrospective cohort study included 551 patients who were grouped into 2 groups: patients who received SAPT (n = 150) and those who received DAPT (n = 401). There were no differences in age ( P = 0.451), gender ( P = 0.063), smoking ( P = 0.941), diabetes mellitus ( P = 0.773), history of myocardial infarction ( P = 0.709), chronic kidney disease ( P = 0.615), atrial fibrillation ( P = 0.306), or cerebrovascular accident ( P = 0.550) between patients who received SAPT versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [87 (58%) vs. 273 (68.08%); P = 0.027], after off-pump CABG [12 (8%) vs. 73 (18.2%); P = 0.003] and in patients with radial artery grafts [1 (0.67%) vs. 32 (7.98%); P < 0.001]. While SAPTs were more commonly used in patients with low ejection fraction [55 (36.67%) vs. 61 (15.21%); P < 0.001] and in patients with postoperative acute kidney injury [27 (18%) vs. 37 (9.23%); P = 0.004]. The attributed treatment effect of DAPT for follow-up major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, -2.08 (95% confidence interval (CI), -20.8-16.7); P = 0.828]. The attributed treatment effect of DAPT on follow-up all-cause mortality was not significantly different from that of SAPT [β, 4.12 (CI, -11.1-19.32); P = 0.595]. There was no difference in bleeding between groups ( P = 0.666).</p><p><strong>Conclusions: </strong>DAPTs were more commonly used in patients with acute coronary syndrome, after off-pump CABG, and with radial artery grafts. SAPTs were more commonly used in patients with low ejection fraction and acute kidney injury. Patients on DAPT after CABG for left-main disease had comparable major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Pathways in Cardiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/HPC.0000000000000342","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/9 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Background: The use of dual antiplatelet therapy (DAPT) after coronary revascularization for left-main disease is still debated. The study aimed to characterize patients who received dual versus single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients.
Results: This multicenter retrospective cohort study included 551 patients who were grouped into 2 groups: patients who received SAPT (n = 150) and those who received DAPT (n = 401). There were no differences in age ( P = 0.451), gender ( P = 0.063), smoking ( P = 0.941), diabetes mellitus ( P = 0.773), history of myocardial infarction ( P = 0.709), chronic kidney disease ( P = 0.615), atrial fibrillation ( P = 0.306), or cerebrovascular accident ( P = 0.550) between patients who received SAPT versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [87 (58%) vs. 273 (68.08%); P = 0.027], after off-pump CABG [12 (8%) vs. 73 (18.2%); P = 0.003] and in patients with radial artery grafts [1 (0.67%) vs. 32 (7.98%); P < 0.001]. While SAPTs were more commonly used in patients with low ejection fraction [55 (36.67%) vs. 61 (15.21%); P < 0.001] and in patients with postoperative acute kidney injury [27 (18%) vs. 37 (9.23%); P = 0.004]. The attributed treatment effect of DAPT for follow-up major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, -2.08 (95% confidence interval (CI), -20.8-16.7); P = 0.828]. The attributed treatment effect of DAPT on follow-up all-cause mortality was not significantly different from that of SAPT [β, 4.12 (CI, -11.1-19.32); P = 0.595]. There was no difference in bleeding between groups ( P = 0.666).
Conclusions: DAPTs were more commonly used in patients with acute coronary syndrome, after off-pump CABG, and with radial artery grafts. SAPTs were more commonly used in patients with low ejection fraction and acute kidney injury. Patients on DAPT after CABG for left-main disease had comparable major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events.
期刊介绍：
Critical Pathways in Cardiology provides a single source for the diagnostic and therapeutic protocols in use at hospitals worldwide for patients with cardiac disorders. The Journal presents critical pathways for specific diagnoses—complete with evidence-based rationales—and also publishes studies of these protocols" effectiveness.
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