MedicalResearch.com Interview with:
Nayan Agarwal MD
Intervention Cardiology Fellow
University of Florida,
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Optimal antiplatelet strategy post CABG remains controversial with guidelines still evolving. Though aspirin monotherapy is the therapy of choice, but some studies have suggested a benefit of dual antiplatelet (DAPT). Question also remains if choice of antiplatelet therapy strategy is influenced by clinical presentation (acute coronary syndrome [ACS] versus non ACS) or CABG technique ( off pump versus on pump).
The current meta-analysis of 8 randomized control trials and 9 observational studies with a total of 11,135 patients demonstrated that at a mean follow up of 23 months, major adverse cardiac events (MACE) (10.3% versus 12.1%, RR 0.84, confidence interval (CI) 0.71-0.99); all-cause mortality (5.7% versus 7.0%, RR 0.67, CI 0.48-0.94) and graft occlusion (11.3% versus 14.2%, RR- 0.79, CI- 0.63- 0.98) were less with DAPT compared with aspirin monotherapy. There was no difference in myocardial infarction, stroke, or major bleeding between the 2 groups. Subgroup analysis demonstrated that benefit of DAPT was independent of clinical presentation (ACS versus non ACS) or CABG technique (off pump versus on pump).
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: DAPT appears to be associated with a reduction in graft occlusion, MACE, and all-cause mortality, without significantly increasing major bleeding compared with aspirin monotherapy in patients undergoing CABG. This benefit is seen in both ACS and non ACS presentation and off pump and on pump CABG. We suggest that post CABG, a strategy of DAPT should be considered.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research should focus on randomized trials to evaluate the role of DAPT post CABG in various subgroups. Also it will be interesting to evaluate the role of P2Y12 inhibitors versus DAPT and the role of newer antiplatelet agents post CABG.
Disclosures: No relevant financial disclosures.
Dr. Anderson is a consultant for Biosense Webster, a Johnson & Johnson Company. Dr. Bhatt discloses the following relationships – Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Cleveland Clinic, Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine, Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Amarin, Amgen, AstraZeneca, Bristol-Myers Squibb, Chiesi, Eisai, Ethicon, Forest Laboratories, Ironwood, Ischemix, Lilly, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, St. Jude Medical (now Abbott); Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, PLx Pharma, Takeda.
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Nayan Agarwal, Ahmed N. Mahmoud, Nimesh Kirit Patel, Ankur Jain, Jalaj Garg, Mohammad Khalid Mojadidi, Sahil Agrawal, Arman Qamar, Harsh Golwala, Tanush Gupta, Nirmanmoh Bhatia, R. David Anderson, Deepak L. Bhatt, Meta-Analysis of Aspirin Versus Dual Antiplatelet Therapy Following Coronary Artery Bypass Grafting, The American Journal of Cardiology (2017), https://doi.org/doi:10.1016/j.amjcard.2017.09.022.
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