ABSTRACT: Preoperative use of clopidogrel increases the risk of bleeding, but its postoperative use has not been studied. We studied early postoperative clopidogrel use in on-pump and off-pump coronary artery bypass grafting.
Data were obtained from the University HealthSystem Consortium database. We conducted a retrospective analysis of data of 15,067 adults who had coronary artery bypass grafting between 2003 and 2006 and received perioperative aspirin alone or in combination with clopidogrel, with the latter administered within 2 days after coronary artery bypass grafting. Logistic regression was used to analyze in-hospital mortality, 30-day readmission, ischemic or thrombotic events, and bleeding events, with propensity score adjustment for clopidogrel treatment.
Combined aspirin and clopidogrel were used in 3268 patients (22%). Compared with aspirin alone, aspirin plus clopidogrel was associated with reductions of in-hospital mortality (0.95% vs 1.78%; adjusted odds ratio: 0.50; 95% confidence interval: 0.25, 0.99) and bleeding events (4.19% vs 5.17%; adjusted odds ratio: 0.70; 95% confidence interval: 0.51, 0.97). Ischemic or thrombotic events were not significantly different (1.29% vs 1.53%; adjusted odds ratio, 0.99; 95% confidence interval: 0.59, 1.64). The relative effect of combined treatment did not differ between on-pump and off-pump coronary artery bypass grafting.
Early postoperative clopidogrel combined with aspirin may be safe and beneficial compared with perioperative aspirin treatment alone, in both on-pump and off-pump coronary artery bypass grafting. However, a possibility of selection bias calls for randomized controlled trials to confirm our findings.
The Journal of thoracic and cardiovascular surgery 12/2009; 138(6):1377-84. · 3.41 Impact Factor
ABSTRACT: Selective serotonin reuptake inhibitors (SSRIs) are commonly used in patients with coronary artery disease and depression, but they have been reported to increase the risk for bleeding. However, data on the short-term outcomes comparing SSRI and non-SSRI antidepressant use after coronary artery bypass grafting (CABG) are limited. A retrospective analysis was conducted of 1,380 adults who received any antidepressants before CABG from 2003 to 2006 at academic medical centers participating in the University HealthSystem Consortium. The primary end point was defined as a composite of in-hospital mortality or any bleeding events, including postprocedural hemorrhage or hematoma, gastrointestinal hemorrhage, and reopening of surgical site. A total of 1,076 adults (78%) received SSRIs. After controlling for propensity of receiving SSRIs compared with non-SSRIs, no significant differences were found in the primary end point (9.4% vs 8.2%, adjusted odds ratio [OR] 1.03, 95% confidence interval [CI] 0.60 to 1.78), any bleeding events (6.5% vs 7.2%, OR 0.93, 95% CI 0.50 to 1.76), or in-hospital mortality (3.1% vs 2.3%, OR 0.88, 95% CI 0.47 to 1.65). There was no increased risk associated with SSRI use when the analysis was restricted to patients who received antiplatelet and anticoagulant therapy for acute coronary syndromes (OR 1.03, 95% CI 0.40 to 2.61) and when examined by age, gender, nonsteroidal anti-inflammatory drug use, and type of CABG (on pump or off pump). In conclusion, compared with non-SSRIs, the preoperative use of SSRIs does not seem to increase the risk for bleeding or in-hospital mortality after CABG.
The American journal of cardiology 06/2009; 103(10):1391-5. · 3.58 Impact Factor
ABSTRACT: To examine whether the volume-mortality relationship in coronary artery bypass grafting (CABG) differs by race and operative risk.
In-hospital mortality after CABG is inversely associated with hospital volume. Racial disparities exist in the outcomes of CABG, possibly due to blacks' high operative risk.
We analyzed 71,949 CABG procedures performed between 2002 and 2005 at 93 academic medical centers participating in the University HealthSystem Consortium. In-hospital mortality was examined across hospital volume categories (very low, <100/yr; low, 100-299/yr; medium, 300-499/yr; and high, > or =500/yr) via logistic regression.
In-hospital mortality was 2.0% in whites and 2.8% in blacks. Controlling for patient risk, geographic region, and proportion of African American patients treated at the hospital, the benefit of higher volume was substantial for blacks but only modest for whites (race-by-volume interaction; P = 0.033). Odds ratios of mortality for increasing volume categories (compared with very low volume) were 0.46, 0.37, and 0.47 among blacks but only 0.85, 0.77, and 0.75 among whites. Racial disparities in mortality existed mostly in very low-volume hospitals. The differential volume effect across the 2 racial groups seemed to be primarily driven by regional patterns, as the volume effect was much more pronounced in the South and the Midwest (region by volume interaction; P = 0.033).
Blacks have greater reduction in mortality than whites by undergoing CABG at higher-volume hospitals, regardless of operative risk. Because of limited generalizability, these findings should be confirmed using more representative database.
Annals of surgery 11/2008; 248(5):886-92. · 7.90 Impact Factor