EXTRA-CARDIAC VASCULAR DISEASE IS ASSOCIATED WITH WORSE FIVE-YEAR CLINICAL OUTCOMES BUT NOT WITH VEIN GRAFT FAILURE AFTER CORONARY ARTERY BYPASS GRAFT SURGERY: INSIGHTS FROM THE PREVENT-IV TRIAL

Background: Transit time flow measurement (TTFM) is used for intraoperative graft measurement to estimate graft failure. PI≤3 was suggested because it shows lower incidence of early graft failure. Objective of the study was to compare myocardial function and clinical outcomes of patients who underwent coronary artery bypass graft (CABG) surgery, between PI≤3 in all grafts (optimal group) and PI >3 in one or more grafts (suboptimal group) by Transit time flow measurement (TTFM).Methods: 90 patients who underwent CABG since June 2012 to December 2014 were included. Patients were classified into 2 groups: Optimal group (n=32) and Suboptimal group (n=58). CABG with intraoperative TTFM was performed as standard. Postoperative outcomes of both groups were compared.Results: Patients whose postoperative EF was increased were found in optimal group more than suboptimal group (62.1% vs 25%, p<0.001). The patients whose postoperative EF increased equal or more than 5% was found in optimal group more than suboptimal group (73.2% vs 25%, p=0.002). Suboptimal group found one patient with myocardial infarction but optimal group found none (3.13% and 0%). Postoperative atrial fibrillation and prolong ventilator more than 48 hours were found in suboptimal group more than optimal group (43.75% vs 37.93%, 62.50% vs 37.93%). In midterm, postoperative follow-up, all-cause mortality in suboptimal group was higher than optimal group (3.13% vs 1.72).Conclusions: Optimal group had patients whose postoperative EF significantly increased more than suboptimal group. Tendency of finding postoperative complications in suboptimal group was more than in optimal group.

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Antithrombotic treatment after coronary artery bypass graft surgery: systematic review and network meta-analysis

BMJ ◽

10.1136/bmj.l5476 ◽

2019 ◽

pp. l5476 ◽

Cited By ~ 16

Author(s):

Karla Solo ◽

Shahar Lavi ◽

Conrad Kabali ◽

Glenn N Levine ◽

Alexander Kulik ◽

...

Keyword(s):

Coronary Artery ◽

Saphenous Vein ◽

Vein Graft ◽

Graft Failure ◽

Saphenous Vein Graft ◽

Meta Analysis ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft ◽

Vein Graft Failure

Abstract Objective To assess the effects of different oral antithrombotic drugs that prevent saphenous vein graft failure in patients undergoing coronary artery bypass graft surgery. Design Systematic review and network meta-analysis. Data sources Medline, Embase, Web of Science, CINAHL, and the Cochrane Library from inception to 25 January 2019. Eligibility criteria for selecting studies Randomised controlled trials of participants (aged ≥18) who received oral antithrombotic drugs (antiplatelets or anticoagulants) to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Main outcome measures The primary efficacy endpoint was saphenous vein graft failure and the primary safety endpoint was major bleeding. Secondary endpoints were myocardial infarction and death. Results This review identified 3266 citations, and 21 articles that related to 20 randomised controlled trials were included in the network meta-analysis. These 20 trials comprised 4803 participants and investigated nine different interventions (eight active and one placebo). Moderate certainty evidence supports the use of dual antiplatelet therapy with either aspirin plus ticagrelor (odds ratio 0.50, 95% confidence interval 0.31 to 0.79, number needed to treat 10) or aspirin plus clopidogrel (0.60, 0.42 to 0.86, 19) to reduce saphenous vein graft failure when compared with aspirin monotherapy. The study found no strong evidence of differences in major bleeding, myocardial infarction, and death among different antithrombotic therapies. The possibility of intransitivity could not be ruled out; however, between-trial heterogeneity and incoherence were low in all included analyses. Sensitivity analysis using per graft data did not change the effect estimates. Conclusions The results of this network meta-analysis suggest an important absolute benefit of adding ticagrelor or clopidogrel to aspirin to prevent saphenous vein graft failure after coronary artery bypass graft surgery. Dual antiplatelet therapy after surgery should be tailored to the patient by balancing the safety and efficacy profile of the drug intervention against important patient outcomes. Study registration PROSPERO registration number CRD42017065678.

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