Amin Daoulah, Wael Qenawi, Ali Alshehri, Maryam Jameel Naser, Youssef Elmahrouk, Mohammed Alshehri, Ahmed Elmahrouk, Mohammed A Qutub, Badr Alzahrani, Nooraldaem Yousif, Amr A Arafat, Wael Almahmeed, Abdelmaksoud Elganady, Ziad Dahdouh, Ahmad S Hersi, Ahmed Jamjoom, Mohamed N Alama, Ehab Selim, Shahrukh Hashmani, Taher Hassan, Abdulrahman M Alqahtani, Abdulwali Abohasan, Mohamed Ajaz Ghani, Faisal Omar M Al Nasser, Wael Refaat, Mina Iskandar, Omar Haider, Adnan Fathey Hussien, Ahmed A Ghonim, Abeer M Shawky, Seraj Abualnaja, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Khalid Z Alshali, Jairam Aithal, Issam Altnji, Haitham Amin, Ahmed M Ibrahim, Turki Al Garni, Abdulaziz A Elkhereiji, Husam A Noor, Osama Ahmad, Faisal J Alzahrani, Abdulaziz Alasmari, Abdulaziz Alkaluf, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Sameer Alhamid, Basim Sait, Abdulrahman H Alqahtani, Mohammed Balghith, Omar Kanbr, Mohammed Abozenah, Amir Lotfi
{"title":"冠状动脉旁路移植术后无保护左主干冠状动脉疾病的单用与双用抗血小板治疗。","authors":"Amin Daoulah, Wael Qenawi, Ali Alshehri, Maryam Jameel Naser, Youssef Elmahrouk, Mohammed Alshehri, Ahmed Elmahrouk, Mohammed A Qutub, Badr Alzahrani, Nooraldaem Yousif, Amr A Arafat, Wael Almahmeed, Abdelmaksoud Elganady, Ziad Dahdouh, Ahmad S Hersi, Ahmed Jamjoom, Mohamed N Alama, Ehab Selim, Shahrukh Hashmani, Taher Hassan, Abdulrahman M Alqahtani, Abdulwali Abohasan, Mohamed Ajaz Ghani, Faisal Omar M Al Nasser, Wael Refaat, Mina Iskandar, Omar Haider, Adnan Fathey Hussien, Ahmed A Ghonim, Abeer M Shawky, Seraj Abualnaja, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Khalid Z Alshali, Jairam Aithal, Issam Altnji, Haitham Amin, Ahmed M Ibrahim, Turki Al Garni, Abdulaziz A Elkhereiji, Husam A Noor, Osama Ahmad, Faisal J Alzahrani, Abdulaziz Alasmari, Abdulaziz Alkaluf, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Sameer Alhamid, Basim Sait, Abdulrahman H Alqahtani, Mohammed Balghith, Omar Kanbr, Mohammed Abozenah, Amir Lotfi","doi":"10.1097/HPC.0000000000000342","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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 versus single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients.</p><p><strong>Results: </strong>This multicenter retrospective cohort study included 551 patients who were grouped into 2 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 versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [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 major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, -2.08 (95% confidence interval (CI), -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 (CI, -11.1-19.32); P = 0.595]. There was no difference in bleeding between groups ( P = 0.666).</p><p><strong>Conclusions: </strong>DAPTs were more commonly used in patients with acute coronary syndrome, 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 major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events.</p>","PeriodicalId":35914,"journal":{"name":"Critical Pathways in Cardiology","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Single Versus Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting for Unprotected Left-Main Coronary Disease.\",\"authors\":\"Amin Daoulah, Wael Qenawi, Ali Alshehri, Maryam Jameel Naser, Youssef Elmahrouk, Mohammed Alshehri, Ahmed Elmahrouk, Mohammed A Qutub, Badr Alzahrani, Nooraldaem Yousif, Amr A Arafat, Wael Almahmeed, Abdelmaksoud Elganady, Ziad Dahdouh, Ahmad S Hersi, Ahmed Jamjoom, Mohamed N Alama, Ehab Selim, Shahrukh Hashmani, Taher Hassan, Abdulrahman M Alqahtani, Abdulwali Abohasan, Mohamed Ajaz Ghani, Faisal Omar M Al Nasser, Wael Refaat, Mina Iskandar, Omar Haider, Adnan Fathey Hussien, Ahmed A Ghonim, Abeer M Shawky, Seraj Abualnaja, Hameedullah M Kazim, Ibrahim A M Abdulhabeeb, Khalid Z Alshali, Jairam Aithal, Issam Altnji, Haitham Amin, Ahmed M Ibrahim, Turki Al Garni, Abdulaziz A Elkhereiji, Husam A Noor, Osama Ahmad, Faisal J Alzahrani, Abdulaziz Alasmari, Abdulaziz Alkaluf, Ehab Elghaysha, Salem Owaid Al Wabisi, Adel N Algublan, Naveen Nasim, Sameer Alhamid, Basim Sait, Abdulrahman H Alqahtani, Mohammed Balghith, Omar Kanbr, Mohammed Abozenah, Amir Lotfi\",\"doi\":\"10.1097/HPC.0000000000000342\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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 versus single antiplatelet therapy (SAPT) after coronary artery bypass grafting (CABG) for unprotected left-main disease and compare the outcomes of those patients.</p><p><strong>Results: </strong>This multicenter retrospective cohort study included 551 patients who were grouped into 2 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 versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [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 major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, -2.08 (95% confidence interval (CI), -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 (CI, -11.1-19.32); P = 0.595]. There was no difference in bleeding between groups ( P = 0.666).</p><p><strong>Conclusions: </strong>DAPTs were more commonly used in patients with acute coronary syndrome, 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 major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events.</p>\",\"PeriodicalId\":35914,\"journal\":{\"name\":\"Critical Pathways in Cardiology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Pathways in Cardiology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1097/HPC.0000000000000342\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/11/9 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Pathways in Cardiology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/HPC.0000000000000342","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/11/9 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
Single Versus 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 versus 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 2 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 versus DAPT. DAPTs were more commonly used in patients with acute coronary syndrome [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 major adverse cerebrovascular and cardiac events was not significantly different from that of SAPT [β, -2.08 (95% confidence interval (CI), -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 (CI, -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 acute coronary syndrome, 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 major adverse cerebrovascular and cardiac events and survival to patients on SAPT, with no difference in bleeding events.
期刊介绍：
Critical Pathways in Cardiology provides a single source for the diagnostic and therapeutic protocols in use at hospitals worldwide for patients with cardiac disorders. The Journal presents critical pathways for specific diagnoses—complete with evidence-based rationales—and also publishes studies of these protocols" effectiveness.
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