title: Impact of clopidogrel plus aspirin versus aspirin alone on the progression of native coronary artery disease after bypass surgery: analysis from the Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) randomized trial.
abstract: BACKGROUND
  The effects of dual antiplatelet therapy with aspirin and clopidogrel on the progression of native coronary artery disease after coronary artery bypass grafting are unknown.
  
  
  RESULTS
  In the Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) trial, a total of 113 patients were randomized to receive aspirin plus clopidogrel or aspirin plus placebo for 1 year after coronary artery bypass grafting. In this secondary analysis, the 92 patients who underwent preoperative and 1-year postoperative angiograms at 2 centers had each of their coronary stenoses graded serially by using 6 thresholds (grade 0 [0%-24%], grade 1 [25%-37%], grade 2 [38%-62%], grade 3 [63%-82%], grade 4 [83%-98%], and grade 5 [99%-100%]). We compared the incidence and degree of evolving coronary artery disease between the 2 treatment groups. A total of 543 preoperative stenoses and occlusions were quantified and followed. At 1-year postoperatively, there were 103 evolving (94 worsened, 9 improved) and 22 new lesions. The right coronary artery territory and sites proximal to a graft were more commonly associated with worsening coronary artery disease (P≤0.02). There were no differences in clinical events between treatment groups, and the proportion of patients with evolving or new lesions was also similar (70% versus 74%, aspirin-clopidogrel versus aspirin-placebo, respectively; P=0.8). However, in evolving or new lesions, the mean grade change (1.1±1.0 versus 1.6±1.1, respectively; P=0.01) and the proportion of new occlusions (7% versus 22%; P=0.02) were lower in the aspirin-clopidogrel group.
  
  
  CONCLUSIONS
  The addition of clopidogrel to aspirin correlates with less worsening of native coronary artery disease 1 year after coronary artery bypass grafting. These findings may help guide post-coronary artery bypass grafting antiplatelet therapy.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00228423.
authors.affiliation: From the Division of Cardiac Surgery (D.U., T.A.-A., M.R.) and Division of Cardiology (M.L.M.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Lynn Heart and Vascular Institute, Boca Raton, FL (A.K.); Division of Cardiac Surgery, Hôpital Laval, Quebec City, Quebec, Canada (P.V.); and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada (M.R.).
authors.forename: Dai
authors.initials: D
authors.lastname: Une
authors.affiliation: From the Division of Cardiac Surgery (D.U., T.A.-A., M.R.) and Division of Cardiology (M.L.M.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Lynn Heart and Vascular Institute, Boca Raton, FL (A.K.); Division of Cardiac Surgery, Hôpital Laval, Quebec City, Quebec, Canada (P.V.); and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada (M.R.).
authors.forename: Talal
authors.initials: T
authors.lastname: Al-Atassi
authors.affiliation: From the Division of Cardiac Surgery (D.U., T.A.-A., M.R.) and Division of Cardiology (M.L.M.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Lynn Heart and Vascular Institute, Boca Raton, FL (A.K.); Division of Cardiac Surgery, Hôpital Laval, Quebec City, Quebec, Canada (P.V.); and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada (M.R.).
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulik
authors.affiliation: From the Division of Cardiac Surgery (D.U., T.A.-A., M.R.) and Division of Cardiology (M.L.M.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Lynn Heart and Vascular Institute, Boca Raton, FL (A.K.); Division of Cardiac Surgery, Hôpital Laval, Quebec City, Quebec, Canada (P.V.); and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada (M.R.).
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: From the Division of Cardiac Surgery (D.U., T.A.-A., M.R.) and Division of Cardiology (M.L.M.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Lynn Heart and Vascular Institute, Boca Raton, FL (A.K.); Division of Cardiac Surgery, Hôpital Laval, Quebec City, Quebec, Canada (P.V.); and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada (M.R.).
authors.forename: Michel
authors.initials: M
authors.lastname: Le May
authors.affiliation: From the Division of Cardiac Surgery (D.U., T.A.-A., M.R.) and Division of Cardiology (M.L.M.), University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Lynn Heart and Vascular Institute, Boca Raton, FL (A.K.); Division of Cardiac Surgery, Hôpital Laval, Quebec City, Quebec, Canada (P.V.); and Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada (M.R.). mruel@ottawaheart.ca.
authors.forename: Marc
authors.initials: M
authors.lastname: Ruel
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use*; D000077144:Clopidogrel; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D023903:Coronary Restenosis / Q000453:epidemiology / Q000517:prevention & control; D023921:Coronary Stenosis / Q000188:drug therapy / Q000601:surgery; D048909:Diabetes Complications / Q000188:drug therapy / Q000601:surgery; D018450:Disease Progression; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: clopidogrel; coronary artery disease; platelet aggregation