Single vs. dual antiplatelet therapy after coronary artery bypass grafting for unprotected left-main coronary disease
Background: The use of dual antiplatelet therapy (DAPT) after coronary revascularization for left-main disease is still debated. The study aimed to characterize patients who received dual vs. single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients.
Results: This multicenter retrospective cohort study included 551 patients who were grouped into two groups: patients who received SAPT (n= 150) and those who received DAPT (n= 401). There were no differences in age (p= 0.451), gender (p= 0.063), smoking (p= 0.941), diabetes mellitus (p= 0.773), history of myocardial infarction (p= 0.709), chronic kidney disease (p= 0.615), atrial fibrillation (p= 0.306) or cerebrovascular accident (p= 0.550) between patients who received SAPT vs. DAPT. DAPTs were more commonly used in patients with acute coronary syndrome (ACS) (87 (58%) vs. 273 (68.08%); p= 0.027), after off-pump CABG (12 (8%) vs. 73 (18.2%); p= 0.003) and in patients with radial artery grafts (1 (0.67%) vs. 32 (7.98%); p<0.001). While SAPTs were more commonly used in patients with low ejection fraction (55 (36.67%) vs. 61 (15.21%); p<0.001) and in patients with postoperative acute kidney injury (27 (18%) vs. 37 (9.23%); p= 0.004). The attributed treatment effect of DAPT for follow-up MACCE was not significantly different from that of SAPT (β: -2.08 (95% confidence interval: - 20.8- 16.7); p= 0.828). The attributed treatment effect of DAPT on follow-up all-cause mortality was not significantly different from that of SAPT (β: 4.12 (95% confidence interval: - 11.1- 19.32); p= 0.595). There was no difference in bleeding between groups (p= 0.666).
Conclusions: DAPTs were more commonly used in patients with ACS, after off-pump CABG, and with radial artery grafts. SAPTs were more commonly used in patients with low ejection fraction and acute kidney injury. Patients on DAPT after CABG for left-main disease had comparable MACCE and survival to patients on SAPT, with no difference in bleeding events.
Daoulah A, Qenawi W, Alshehri A, Jameel Naser M, Elmahrouk Y, Alshehri M, Elmahrouk A, Qutub MA, Alzahrani B, Yousif N, Arafat AA, Almahmeed W, Elganady A, Dahdouh Z, Hersi AS, Jamjoom A, Alama MN, Selim E, Hashmani S, Hassan T, Alqahtani AM, Abohasan A, Ghani MA, Al Nasser FOM, Refaat W, Iskandar M, Haider O, Fathey Hussien A, Ghonim AA, Shawky AM, Abualnaja S, Kazim HM, Abdulhabeeb IAM, Alshali KZ, Aithal J, Altnji I, Amin H, Ibrahim AM, Al Garni T, Elkhereiji AA, Noor HA, Ahmad O, Alzahrani FJ, Alasmari A, Alkaluf A, Elghaysha E, Al Wabisi SO, Algublan AN, Nasim N, Alhamid S, Sait B, Alqahtani AH, Balghith M, Kanbr O, Abozenah M, Lotfi A. Single vs. dual antiplatelet therapy after coronary artery bypass grafting for unprotected left-main coronary disease. Crit Pathw Cardiol. 2023 Nov 10. doi: 10.1097/HPC.0000000000000342. Epub ahead of print.