Postoperative clopidogrel improves mid-term outcome after off-pump coronary artery bypass graft surgery: a prospective study
| Autor: | Haiyan Cui, Ayhan A. Zia, Ali Can Vuran, Aydın Aytaç, Ahmet Tayfun Gürbüz |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Ticlopidine Time Factors medicine.medical_treatment Coronary Artery Bypass Off-Pump Myocardial Infarction Coronary Disease Sudden cardiac death Angina Recurrence Risk Factors Internal medicine medicine Humans cardiovascular diseases Myocardial infarction Postoperative Period Prospective Studies Prospective cohort study Off-pump coronary artery bypass Aged Aspirin Chi-Square Distribution business.industry Anticoagulants General Medicine Middle Aged medicine.disease Clopidogrel Surgery Treatment Outcome Heart failure Anesthesia Cardiology Regression Analysis Drug Therapy Combination Female Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 29(2) |
| ISSN: | 1010-7940 |
| Popis: | Objective: Clopidogrel decreases recurrent ischemic events and improves intracoronary stent patency. There are scarce data on the effect of short-termandlong-termclopidogrel on symptomrecurrence andadversecardiacevents following off-pumpcoronaryarterybypass graftsurgery (OPCAB). Methods: Postoperative antiplatelet medication use was prospectively evaluated in 591 OPCAB patients. Clopidogrel was administered for 30 days in 186 patients and 139 received long-term clopidogrel (mean 33.6 12.0 months) in addition to aspirin. Follow-up was 37.7 13.4 months. Symptom recurrence (angina and congestive heart failure), adverse cardiac events (myocardial infarction, coronary reintervention, and suddencardiac death),andoverallmortalitywere prospectively recorded.MultivariateCoxregressionanalysiswasusedto evaluatepredictorsof end points. Results: There was no difference with respect to preoperative risk factors between patient groups. In the multivariate analysis, postoperative clopidogrel independently decreased symptom recurrence (p < 0.0001, OR 0.3 [0.15—0.99]; 95% CI) and adverse cardiac events (p < 0.0001, OR 0.2 [0.10—0.45]; 95% CI). Clopidogrel receivers had significantly lower angina recurrence, myocardial infarction, coronary reintervention, and sudden cardiac death during follow-up. There was no difference in the incidence of end points between short-term (30 days) and long-term receivers of the drug. There were 17 bleeding complications (4 major and 13 minor) in 15 patients during the follow-up period. Of the 15 patients, 6 were on clopidogrel in addition to aspirin (1.8%) while the remaining 9 were on aspirin (3.3%) only at the time of bleeding (p = 0.8). Conclusions: Clopidogrel therapy was independently associated with decreased symptom recurrence and adverse cardiac events following OPCAB. Extending clopidogrel use beyond 30 days did not have a significant effect on defined end points. # 2005 Elsevier B.V. All rights reserved. |
| Databáze: | OpenAIRE |
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