Dual Antiplatelet Therapy Found Beneficial Over Aspirin Alone Following CABG Surgery

MedicalResearch.com Interview with:

Nayan Agarwal MD Intervention Cardiology Fellow, University of Florida, Gainesville, FL

Dr. Agarwal

Nayan Agarwal MD
Intervention Cardiology Fellow
University of Florida,
Gainesville, FL

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).

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NEJM: On-Pump CABG Should Continue To Be Standard Surgical Treatment

MedicalResearch.com Interview with:

A. Laurie Shroyer, Ph.D., M.S.H.A. WOC Health Science Officer Northport VAMC Research and Development Office (151) Northport, NY 11768 Professor and Vice Chair for Research, Department of Surgery Stony Brook University, School of Medicine Stony Brook, NY

Dr. Shroyer

A. Laurie Shroyer, Ph.D., M.S.H.A.
WOC Health Science Officer
Northport VAMC
Research and Development Office (151)
Northport, NY 11768
Professor and Vice Chair for Research, Department of Surgery
Stony Brook University, School of Medicine
Stony Brook, NY 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Since the 1990’s, two different approaches have been commonly used by cardiac surgeons to perform an adult coronary artery bypass graft (CABG) procedure, these approaches have been referred to as  “on-pump” (with cardiopulmonary bypass) or “off-pump” (without cardiopulmonary bypass) procedures. The Department of Veterans Affairs (VA) Randomized On/Off Bypass Follow-up Study” (ROOBY-FS) compared the relative performance of off-pump versus on-pump approaches upon 5-year patients’ clinical outcomes including mortality and major adverse cardiovascular events.

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DuraGraft® Vascular Graft Evaluated to Prevent Vein Graft Failure After CABG

MedicalResearch.com Interview with:

Miguel Haime, MD VA Boston Healthcare System and Boston Medical Center Boston, MA

Dr. Miguel Haime

Miguel Haime, MD
VA Boston Healthcare System and Boston Medical Center
Boston, MA

Dr. Haime discusses an abstract about Somahlution DuraGraft during a rapid response session at the 2016 annual meeting of the European Association for Cardio-Thoracic Surgery (EACTS; 1–5 October, Barcelona, Spain)

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Coronary artery bypass grafting (CABG) surgery is the standard of care for multi-vessel coronary heart disease. During CABG, we use saphenous vein grafts as bypass conduits for surgical revascularization. Pathophysiological changes that occur in vein grafts during the surgical procedure can compromise the durability and patency of the graft and increase the risk of vein graft failure.

At the European Association for Cardio-Thoracic Surgery (EACTS) annual meeting, we presented results from a retrospective, non-randomized study conducted at VA Boston Healthcare System to evaluate the Real World Evidence of DuraGraft®, a vascular graft treatment designed to prevent vein graft failure after CABG.

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IMAGINE Trial: Worse Outcomes For Women Than Men After CABG

Saskia Haitjema MD PhD candidate Division Heart and Lung, Laboratory of Experimental Cardiology University Medical Center UtrechtMedicalResearch.com Interview with:
Saskia Haitjema
MD PhD candidate
Division Heart and Lung, Laboratory of Experimental Cardiology
University Medical Center Utrecht

Medical Research: What is the background for this study? What are the main findings?

Response: Although cardiovascular diseases are often considered a disease of men, more women than men die each year of cardiovascular diseases. Sex-differences are increasingly being researched and acknowledged. For treatment and prognosis of coronary artery disease, however, many discrepancies exist between studies that investigated sex-differences. For example, it remains unclear whether the observed differences in the outcome after coronary artery bypass grafting (CABG) are due to a different risk burden between men and women or whether female sex is an independent risk factor.

In a group of 2553 patients followed up during a median of 2.5 years after CABG we found an increased risk for worse outcome in women versus men. We found a strong indication for female sex as an independent risk factor, but lacked power to definitively prove th

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Sleep Apnea Predicts Atrial Fibrillation after CABG

MedicalResearch.comInterview with:
Amro Qaddoura BHSc
Research Student of Adrian Baranchuk, MD
Department of Medicine, Queen’s University, Kingston, Ontario, Canada

MedicalResearch: What is the background for this study? What are the main findings?

Response: This publication was a letter to the editor in response to comments on our recent systematic review and meta-analysis that showed obstructive sleep apnea to be a strong predictor of atrial fibrillation after coronary artery bypass grafting (CABG). See the details in another interview: https://medicalresearch.com/heart-disease/sleep_apnea_increases_risk_of_atrial_fibrillation_after_bypass_surgery/8369/

The letter to the editor included an analysis not included in the initial publication, which provided more evidence that obstructive sleep apnea is a predictor of atrial fibrillation after CABG surgery.

As well, it elucidated the reasoning behind one of the analyses that we chose to conduct.

MedicalResearch: What should clinicians and patients take away from your report?

Response:  Healthcare specialists of multiple disciplines should equip themselves with the necessary tools and knowledge to be able to screen and diagnose obstructive sleep apnea.

For patients, it provides further incentive to report any sleep disturbances or snoring to their healthcare providers so that the patients can be optimally cared for and managed.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Response:  Only one study that we are aware of investigated the association between severe obstructive sleep apnea and atrial fibrillation after CABG surgery. This provides an impetus to explore this association further.

As well, although the evidence to date indicates that obstructive sleep apnea is a risk factor for atrial fibrillation after CABG surgery, larger high-quality studies may help to confirm the findings of our review.

Citation:

Obstructive Sleep Apnea is a Risk Factor for Post Coronary Artery Bypass Graft Atrial Fibrillation
Qaddoura, Amro et al.
Canadian Journal of Cardiology , Volume 30 , Issue 12 , 1516 – 1522

 

Newer Drug-Eluting Stents Narrow Gap Between Cardiac Bypass and Stent Surgery Outcomes

Sripal Bangalore, MD, MHA Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016MedicalResearch.com Interview with:
Sripal Bangalore, MD, MHA
Director of Research, Cardiac Catheterization Laboratory,
Director, Cardiovascular Outcomes Group,
Associate Professor of Medicine,
New York University School of Medicine,
New York, NY 10016

Medical Research: What are the main findings of the study?

Dr. Bangalore: We found that while CABG was associated with mortality benefit when compared with bare metal stents or first generation drug eluting stent, the gap between CABG and PCI was smaller and non significant when PCI was with newer generation DES. The same was true for repeat revascularization with the magnitude of benefit with CABG descending considerable from comparison with balloon angioplasty to newer generation DES.
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CABG Surgery in Patients with Acute Coronary Syndromes and Chronic Kidney Disease

Martin Holzmann, MD, PhD Department of Emergency Medicine, Karolinska University Hospital Stockholm Sweden.MedicalResearch.com Interview with:
Martin Holzmann, MD, PhD
Department of Emergency Medicine,
Karolinska University Hospital
Stockholm Sweden.


MedicalResearch.com: What are the main findings of the study?

Dr. Holzmann: The main finding is that patients with renal dysfunction are at increased risk of cardiovascular events after undergoing CABG for acute coronary syndromes.
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Coronary Artery Bypass Grafting: On-Pump vs Off-Pump Trends and Mortality

Faisal G. Bakaeen, MD FACS Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasThe Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, TexasMedicalResearch.com Interview with:
Faisal G. Bakaeen, MD FACS
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TexasThe Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke’s Episcopal Hospital, Houston, Texas

 

MedicalResearch.com: What are the main findings of the study?

Dr. Bakaeen:  The relative use of off-pump CABG peaked at 24% in 2003, followed by a slow decline after that to about 19%. In addition, the conversion rate from off- to on-pump decreased with time and has stayed below 3.5% in recent years. Perioperative mortality rates decreased over time for both on- and off-pump CABG and have stayed below 2% since 2006. The mortality associated with converted cases was high regardless of the surgery year.
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COPD and Coronary Artery Bypass Surgery

MedicalResearch.com Interview with: Hossein Almassi, MD

Professor, Cardiothoracic Surgery
Medical College of Wisconsin and
Zablocki VA Medical Center
Milwaukee, Wi, 53226

MedicalResearch.com: What are the main findings of the study?

Answer: The main findings of this study were that off-pump coronary bypass grafting did not have a positive differential impact on outcome of patients with COPD as compared to the standard operation performed on cardiopulmonary bypass.
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