Effects of aprotinin on short-term and long-term outcomes after coronary artery bypass grafting surgery.
BACKGROUND
Recent studies demonstrated that aprotinin use would increase the short-term and long-term mortality and complications after coronary artery bypass grafting (CABG). This study was to investigate effects of aprotinin during isolated primary CABG on short-term and long-term outcomes in Chinese patients.


METHODS
We studied 5,103 consecutive Chinese patients who underwent isolated primary CABG from 1999 to 2005. Of all the patients, 4,122 received aprotinin during operation (aprotinin group) and 981 received no aprotinin or other antifibrinolytic therapy (control group). Short-term and long-term mortality and major complications were analyzed with multivariate regression analysis. Propensity adjustment method was used to minimize the selection bias between the two groups, and propensity matching method was used to yield two well-matched groups for further comparison.


RESULTS
Blood loss after operation was significantly reduced in the aprotinin group compared with the control group (p < 0.001). Aprotinin use was neither associated with the perioperative mortality (p = 0.45, relative risk, 1.34) or major complications, nor was it associated with long-term mortality (p = 0.21, relative risk, 1.26) and major adverse cardiac and cerebrovascular events (p = 0.82, relative risk, 0.98). After propensity adjustment for the baseline characteristics, we obtained similar results. In addition, comparison between the two well-matched groups showed no significant difference either in baseline characteristics or in short-term and long-term outcomes.


CONCLUSIONS
Aprotinin use during isolated primary CABG reduced blood loss significantly, but was not associated with short-term or long-term mortality and complications. Aprotinin use in relatively low-risk CABG patients was effective and safe in a Chinese (Asian) population.
Wang
Xianqiang
X
Department of Cardiovascular Surgery, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China.
Zheng
Zhe
Z
Ao
Hushan
H
Zhang
Shiju
S
Wang
Yang
Y
Zhang
Hao
H
Hu
Shengshou
S
D000368:Aged; D007611:Aprotinin / Q000008:administration & dosage* / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D016022:Case-Control Studies; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006490:Hemostatics / Q000008:administration & dosage / Q000009:adverse effects; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011336:Probability; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D006490:Hemostatics; D007611:Aprotinin