A Systematic Review and Meta-Analysis of Dual Antiplatelet Therapy Versus Antiplatelet Monotherapy After Coronary Artery Bypass Graft Surgery
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Publication Date
3-2018
Keywords
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Disciplines
Cardiology
Abstract
Background
The role of dual antiplatelet therapy (DAPT) after coronary artery bypass grafting (CABG) is controversial, particularly among patients with stable ischemic heart disease (IHD).
Methods
We performed a systematic review and meta-analysis comparing DAPT to antiplatelet monotherapy following CABG. Subgroup analyses were performed in randomized trials (RCTs), stable IHD, extended duration DAPT (≥ 6 months), and long-term follow-up (≥ 2 years).
Results
Twenty studies and 19,795 patients were included, of which 7301 (37%) received DAPT after CABG. Overall, DAPT was associated with a significant reduction in cardiovascular (CV) mortality (OR 0.66; p=0.01; Fig 1A) and a trend towards lower all-cause mortality (0.78; p=0.08). There were no between group differences in total mortality, CV mortality, myocardial infarction, or stroke in thesubanalyses of RCTs, stable IHD, extended DAPT, and long-term follow-up. Vein graft occlusion up to 1 year after CABG was significantly lower with DAPT in the overall analysis (OR 0.64; p=0.01; Fig 1B) and in RCTs (OR 0.58; P
Conclusion
Although DAPT is associated with a lower CV mortality in an unselected population after CABG, our findings suggest that routine DAPT after CABG does not improve clinical endpoints when evaluated in RCTs or in patients with stable IHD, but does reduce rates of early vein graft occlusion.
Clinical Institute
Cardiovascular (Heart)
Specialty/Research Institute
Cardiology
Specialty/Research Institute
Center for Cardiovascular Analytics, Research + Data Science (CARDS)
Conference / Event Name
American College of Cardiology Annual Scientific Session & Expo
Location
Orlando, FL
DOI
DOI: 10.1016/S0735-1097(18)30613-2
