title: Long-term effect of dual antiplatelet treatment after off-pump coronary artery bypass grafting.
abstract: OBJECTIVE
  Recent studies have found increased long-term cardiovascular morbidity after off-pump coronary artery bypass surgery (OPCAB). We evaluated the efficacy and safety of dual antiplatelet therapy (DAT) in the prevention of cardiovascular events at two years after OPCAB surgery.
  
  
  METHODS
  Retrospective study that included all patients that underwent OPCAB surgery in our institution between 2009 and 2010. Single or dual antiplatelet therapy was initiated at hospital discharge, and its effect in patients' prognosis was analyzed. Follow-up was conducted by telephone and using the hospital databases. The primary end-point was the composite of acute coronary syndrome (ACS), revascularization, stroke, or cardiovascular death.
  
  
  RESULTS
  The study included 237 patients divided into: (A) 128 patients who received single antiplatelet therapy and (B) 109 patients who received dual antiplatelet therapy. The mean follow-up was 23.85 months (standard deviation 0.5 months). 13.9% of patients had a primary end-point event. Patients in group A had a higher event rate compared with group B (18.8% vs. 8.3%, p = 0.02), with a significant reduction in hospital readmissions for ACS (10.9% vs. 3.7%, p = 0.035). In the multivariate analysis, dual antiplatelet therapy was an independent protective factor in the occurrence of events (hazard ratio = 0.395, 95% CI, 0.176 to 0.885, p = 0.024). There were no significant differences between the two groups with respect to bleeding events.
  
  
  CONCLUSIONS
  Dual antiplatelet therapy after OPCAB surgery is associated with a decrease in the appearance of new cardiovascular events, due to a reduction in the number of hospital readmissions for ACS.
authors.affiliation: Department of Cardiac Surgery, University Central Hospital of Asturias, Oviedo, Asturias, Spain. jose_lm78@icloud.com
authors.forename: José
authors.initials: J
authors.lastname: López
authors.forename: Carlos
authors.initials: C
authors.lastname: Morales
authors.forename: Pablo
authors.initials: P
authors.lastname: Avanzas
authors.forename: Francisco
authors.initials: F
authors.lastname: Callejo
authors.forename: Daniel
authors.initials: D
authors.lastname: Hernández-Vaquero
authors.forename: Juan C
authors.initials: JC
authors.lastname: Llosa
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000517:prevention & control; D000368:Aged; D001241:Aspirin / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D000077144:Clopidogrel; D015331:Cohort Studies; D047549:Coronary Artery Bypass, Off-Pump; D004359:Drug Therapy, Combination; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D011379:Prognosis; D012189:Retrospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin