Long-term Graft Patency And Outcomes Of Different Antiplatelet Therapies After Coronary Artery Bypass Grafting

ObjectiveTo compare the long-term graft patency, MACCEs (major adverse cardiac andcerebrovascular events) and bleeding events of three different antiplatelet therapies afterOPCAB(Off-pump Coronary Artery Bypass) through a prospective randomizedcontrolled clinic trial.Participants and methodsFrom August2008to October2009,180consecutive patients received isolate OPCAB(off-pump coronary artery bypass) surgery were randomly assigned tothree groups:GroupA, receiving aspirin100mg daily;Group C, receiving clopidogrel75mg daily;and Group AC,receiving aspirin100mg plus clopidogrel75mg daily. Each groupincludes60cases equally and antiplatelet treatments were initiated postoperatively.Grafts patency in the5thyear measured by cardiac computed tomographyangiographyand adverse events (MACCEs and bleeding events) during5years were compared inthree groups.Result1. Follow-upOf all the180paticipants,166(92.2%)completed5-year follow-up and was enrolledin adverse events analysis, and136(75.6%) underwent the CTA examination and wasenrolled in graft patency analysis.2. The rate of achieving goal blood pressure, blood glucose and blood lipidThe overall rate of achieving goal blood presure in the5thyear was84.4%, ofachieving goal blood glucose was88.9%, and of achieving goal blood lipid was91.9%. There were no significant differencesbetweenthree groups(P>0.05).3. Grafts patency rate The overall LIMA(internal mammary artery) grafts patency rate in the5thyear was91.2%,and saphenous vein graftspatency was86.3%. The LIMA grafts patency ratein3groups(A,C and AC group) were88.2%、91.1%and92.5%respectively, with nosignificantdifferences betweenthree groups(P>0.05). The saphenous grafts patencyrate in there groups(A,C and AC group) were85.2%，86.1%and88.1%respectively,with no significant differences betweenthree groups(P>0.05).4. MACCEs26(15.7%) MACCEs occurredduring the5years,including3(1.8%) cardiogenicdeaths,9(5.4%) strokes,5(3.0%) myocardial revascularizations and9(5.4%)non-fatal myocardial infractions. There were no significantdifferences between threegroups in terms of cardiac deaths, strokes, myocardial revascularizations, non-fatalmyocardial infractions and total MACCEs (P>0.05).5. Bleeding events20(12.0%) bleeding events occurredduring the5years, including4(2.4%) moderatebleeding events,16(9.6%) mild bleeding events, and nosevere or life-threateningbleeding events occurred. There were no significantdifferences between three groupsin terms of moderatebleeding events, mild bleeding events and total bleeding events(P>0.05).Conclusion1. The long-term grafts patency rate of LIMA and saphenous vein grafts did not reachsignificant difference between three antiplatelet therapies.2. The risk of MACCEsdid not reach significant difference between three antiplatelettherapies.3. The antiplatelet therapy of aspirin plus clopidogrel after CABG is no more effectivecompared to aspirin alone or clopidogrel alone in the long-term clinic outcomes.4. The risk of bleeding events did not reach significant difference between threeantiplatelet therapies.