title: Single versus double antiplatelet therapy in patients undergoing coronary artery bypass grafting with coronary endarterectomy: mid-term results and clinical implications.
abstract: Coronary endarterectomy (CE) represents a useful adjunctive technique to coronary artery bypass grafting (CABG) in the presence of diffuse coronary artery disease. Nevertheless, the long-term patency of the graft remains unclear, and no standard anticoagulation and antiplatelet protocols exist for use after CE. The aim of this retrospective study was to evaluate and possibly to clarify the role of single (SAT) versus dual antiplatelet therapy (DAT) at mid-term follow-up.
  
  
  
  Between January 2006 and December 2013, CE was performed in 90 patients (mean age 67 ± 8.2 years) who also underwent isolated CABG. After surgery, 20 patients received aspirin 100 mg daily (SAT group), and 52 patients received aspirin plus clopidogrel 75 mg daily (DAT group). Clopidogrel was discontinued in the DAT group 12 months after the operation.
  
  
  
  The overall in-hospital mortality rate was 2.7% (SAT 0% vs DAT 3.8%; P = ns). Perioperative myocardial infarction was 12.3% (SAT 15.0% vs DAT 11.5%; P = ns), and major bleeding requiring surgical re-exploration was 4.1% (SAT 10.0% vs DAT 1.9%; P = ns). Mean follow-up duration was 71.3 ± 32.7 months (median 79 months), and was 100% complete (5208/5208 pt-months). At 7 years of follow-up, freedom from cardiac death was 84 ± 9% in group SAT versus 85 ± 5% in group DAT (P = ns); freedom from new percutaneous coronary intervention was 93 ± 6% versus 100% (P = ns), and freedom from major adverse cardiac and cerebrovascular events was 73 ± 10% versus 75 ± 6% (P = ns).
  
  
  
  In patients with diffuse coronary disease, CE is a safe and feasible technique with acceptable mid-term results. No differences were observed in terms of major clinical outcomes between patients treated with single versus dual antiplatelet therapy at least in a mid-term period of follow-up.
authors: Cardiac Surgery Division, Tor Vergata University Policlinic, Rome, Italy.
authors: Marco
authors: M
authors: Russo
authors: Cardiac Surgery Division, Tor Vergata University Policlinic, Rome, Italy.
authors: Paolo
authors: P
authors: Nardi
authors: Cardiac Surgery Division, Tor Vergata University Policlinic, Rome, Italy.
authors: Guglielmo
authors: G
authors: Saitto
authors: Cardiac Surgery Division, Tor Vergata University Policlinic, Rome, Italy.
authors: Emanuele
authors: E
authors: Bovio
authors: Cardiac Surgery Division, Tor Vergata University Policlinic, Rome, Italy.
authors: Antonio
authors: A
authors: Pellegrino
authors: Cardiac Surgery Division, Tor Vergata University Policlinic, Rome, Italy.
authors: Antonio
authors: A
authors: Scafuri
authors: Cardiac Surgery Division, Tor Vergata University Policlinic, Rome, Italy.
authors: Giovanni
authors: G
authors: Ruvolo
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D000077144:Clopidogrel; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004359:Drug Therapy, Combination; D004691:Endarterectomy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012189:Retrospective Studies; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Antiplatelet therapy; Coronary artery disease; Coronary endarterectomy; Myocardial revascularization