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DAPT confers improved outcomes at 30 days for CABG
Patients who underwent CABG and were treated with dual antiplatelet therapy with aspirin and clopidogrel had fewer 30-day adverse outcomes compared with those treated with aspirin alone, according to a study published in The American Journal of Cardiology.
At 1 year, there were no significant cost or outcome differences between the groups.
In this subanalysis of the ROOBY trial, Ramin Ebrahimi, MD, health sciences clinical professor of medicine at the David Geffen School of Medicine at UCLA and researcher in the department of cardiology at the VA Greater Los Angeles Healthcare System, and colleagues reviewed data from 1,525 patients who underwent CABG. Patients were treated with either DAPT with aspirin and clopidogrel (n = 1,014) or aspirin only (n = 511), which was decided by their surgeon. Data including comorbidities, demographics, pharmacotherapy, laboratory testing and clinical outcomes were included in the analysis.
The primary endpoints were a composite of major complications or death within 30 days after CABG or before discharge and a composite of repeat coronary revascularization, death or nonfatal MI at 1 year. Costs during the hospitalization up to 1 year were compared between the two groups.
Compared with patients given aspirin only, those given DAPT had lower rates of on-pump CABG (36.6% vs. 57.1%; P = .001), preoperative left ventricular ejection fraction of at least 45% (78.8% vs. 85.7%; P < .001) and endoscopic vein harvesting (30% vs. 42.8%; P < .001).
After CABG, patients in the aspirin-only group were more likely to have early administration of aspirin therapy compared with the DAPT group. Patients given aspirin alone were also more likely to start therapy at 325 mg instead of 81 mg.
The DAPT group had lower rates of 30-day composite outcomes vs. the aspirin-only group (3.3% vs. 7.1%; P = .003), although composite outcomes were equal between both groups at 1 year (12% vs. 12%; P = 1).
Total index hospitalization costs and total 1-year costs did not differ between the two groups. Results were unchanged with propensity analyses.
“Future studies are needed to further examine the role of dual antiplatelet therapy after CABG and to assess the potential benefits of individualizing therapy based on measurements of platelet inhibition,” Ebrahimi and colleagues wrote. – by Darlene Dobkowski
Disclosure: Ebrahimi reports he is a speaker for Bristol-Myers Squibb, Janssen, Pfizer, Regeneron and Sanofi-Aventis. The other authors report no relevant financial disclosures.