Syetematic Review Of Long-Term Outcomes For Chinese Of The Choice Of Antiplatelet Drugs After Off-pump Coronary Artery Bypass Grafting

Although coronary artery bypass grafting(CABG)is an important treatment of ischemic cardiomyopathy,and can improve the prognosis of patients,but a few months to several years after surgery,the patients with coronary artery and grafts can happen on the progress of atherosclerotic lesions,and lead to the occurrence of ischemic events.Antiplatelet therapies after CABG play an important role in maintaining the smooth flow of coronary arteries and bridge vessels and preventing adverse cardiovascular events.The 2010 European Society of Cardiology and the European Association for Cardio-thoracic surgery(ESC/EACTS)cardiopulmonary resuscitation guidelines recommend thatantiplatelet regiments after CABG are combined with aspirin and clopidogrel.The IA recommendation in the 2011 American College of Cardiology and the American Heart Association(ACC/AHA)CABG surgery guidelines is an indefinite routine aspirin antiplatelet therapy after CABG.In2013,the guidelines for Chinese antiplatelet therapy recommended that the patients after CABG should be treated with a single aspirin,only with clopidogrel if it was prohibited or not tolerable.In fact,however,as aspirin resistance(AR)phenomenon exists generally,both at home and abroad for a considerable amount of cardiac surgery doctors with experience of postoperative routine use of dual antiplatelet treatment could achieve satisfactory antiplatelet effect.In recent years,there have been a number of prospective studies on the efficacy of aspirin and clopidogrel combined with coronary artery bypass grafting.However,these studies are not consistent.Some believe thatdual antiplatelet is superior to aspirin alone,while others believe that dual antiplatelet does not bring clinical benefit.So can the combination of aspirin and clopidogrel improve the prognosis of patients after coronary artery bypass surgery?There is no sufficient evidence to prove this problem.ObjectiveThe purpose of this study was to compare the effects of different antiplatelet regimens on the long-term prognosis of Chinese patients after OPCAB surgery,so as to provide the best choice for Chinese clinicians and patients.Methods Databases including Pubmed,The Cochrane Library,Embase database,CNKI,China Biomedical Database(CBM),WanFang database and VIP,time from construction to July 2017.We collect all randomized controlled trials and case-control studies on the long-term prognosis of Chinese patients after OPCAB with antiplatelet drugs.The Cochrane collaboration system evaluation method for the evaluation of literature qualitywillbeused.Meta-analysiswasconductedusingRevMan5.3software.Comparing two groups of patients with Major bleeding Events,Major Adverse Cardic and Cerebrovascular Events(MACCEs),grafts patency rate in the first year and grafts patency rate in the 3~thh year.ResultFinally,8 case control studies with 1019 patients were included,of which 506 cases were in the aspirin combined-clopidogrel group(A+C),and 513 cases in the aspirin group(A).Meta analysis results show that:There was no significant difference between the two in the postoperative incidence of major bleeding events[[OR=1.62,95%CI(0.70,3.76),P=0.26],Major Adverse Cardic and Cerebrovascular Events(MACCEs)[OR=1.82,95%CI(0.86,3.86),P=0.12],Saphenous vein grafts patency rate in the first year[OR=0.74,95%CI(0.50,1.08),P=0.12],Left internal Mammary Atery patency rate in the first year[OR=1.72,95%CI(0.90,3.29),P=0.10],Saphenous vein grafts patency rate in the 3~thh year[OR=1.42,95%CI(0.88,2.32),P=0.15]and Left internal Mammary Atery patency rate in the 3~thh year[OR=1.06,95%CI(0.57,1.98),P=0.85].Conclusion1.There was no statistically significant difference betweentwo different antiplatelet therapiesLeft internal Mammary Atery patency rate and Saphenous vein grafts patency rate after OPCAB.2.There was no statistically significant difference between two different antiplatelet therapies on the risk of major bleeding events after OPCAB.3.There was no statistically significant difference between the two different antiplatelet therapies on the risk of Major Adverse Cardic and Cerebrovascular Events(MACCEs)after OPCAB.4.Compared with aspirin alone,there was no significant long-term benefit with dual antiplatelet after OPCAB in this study.