Original articleAdult cardiacHospital Variability Drives Inconsistency in Antiplatelet Use After Coronary Bypass
Section snippets
Patient Data
The Virginia Cardiac Services Quality Initiative includes 19 hospitals and surgical groups in the region. Registry data includes 99% of all adult cardiac surgery in the region and methodologies for clinical data acquisition have been described previously.14 Standard Society of Thoracic Surgeons definitions were used for all variables.15 Institutional Society of Thoracic Surgeons data are voluntarily submitted by each center and compiled in a central database to be used for quality improvement.
Results
A total of 7314 patients who underwent isolated CABG in the setting of a recent AMI were included in the analysis, after excluding 167 (2.2%) patients with missing discharge medication data (Figure 1). Of these, 4164 (56.9%) underwent surgery in the early era and 3149 (43.1%) in the late era.1 In the late era, patients were more likely to have diabetes (50.5% vs 47.6%, P = .014), hypertension (86.8% vs 85.0, P = .031), and heart failure (31.2% vs 24.0%, P < .001) and were more likely to have
Comment
In this analysis of a regional quality database containing over 7000 patients who underwent CABG after AMI, we observed a relatively low rate of discharge on DAPT after CABG (31.2%). Although there was a significant increase in DAPT over time, this plateaued in 2014. This change appears to be in part affected by evolving patient demographics, with a surgical population at higher overall ischemic risk and more patients presenting for CABG after previous PCI. Moreover, there was significant
References (35)
- et al.
Evaluation of prasugrel compared with clopidogrel in patients with acute coronary syndromes: design and rationale for the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel Thrombolysis In Myocardial Infarction 38 (TRITON-TIMI 38)
Am Heart J
(2006) - et al.
Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction
J Am Coll Cardiol
(2011) - et al.
Adding CABG to the dual antiplatelet salad
J Am Coll Cardiol
(2017) - et al.
Mortality benefit with prasugrel in the TRITON-TIMI 38 coronary artery bypass grafting cohort: risk-adjusted retrospective data analysis
J Am Coll Cardiol
(2012) - et al.
2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
J Am Coll Cardiol
(2016) - et al.
2014 AHA/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
J Am Coll Cardiol
(2014) - et al.
Compliance with guideline-directed medical therapy in contemporary coronary revascularization trials
J Am Coll Cardiol
(2018) - et al.
Antiplatelet effects of ticagrelor versus clopidogrel after coronary artery bypass graft surgery: a single-center randomized controlled trial
J Thorac Cardiovasc Surg
(2019) - et al.
Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery: results from the PLATO (Platelet Inhibition and Patient Outcomes) trial
J Am Coll Cardiol
(2011) - et al.
Randomized trial of aspirin and clopidogrel versus aspirin alone for the prevention of coronary artery bypass graft occlusion: the Preoperative Aspirin and Postoperative Antiplatelets in Coronary Artery Bypass Grafting study
Am Heart J
(2010)
Aspirin plus clopidogrel therapy increases early venous graft patency after coronary artery bypass surgery a single-center, randomized, controlled trial
J Am Coll Cardiol
Meta-analysis of aspirin versus dual antiplatelet therapy following coronary artery bypass grafting
Am J Cardiol
Meta-analysis of effect of single versus dual antiplatelet therapy on early patency of bypass conduits after coronary artery bypass grafting
Am J Cardiol
Dual antiplatelet therapy use by Canadian cardiac surgeons
J Thorac Cardiovasc Surg
Pattern and predictors of dual antiplatelet use after coronary artery bypass graft surgery
J Thorac Cardiovasc Surg
Impact of institutional culture on rates of transfusions during cardiovascular procedures: the Michigan experience
Am Heart J
Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective
Eur Heart J
Cited by (2)
No Excuse for Inadequate Adherence to Guideline-Driven Medical Therapy
2020, Annals of Thoracic SurgeryDual antiplatelet therapy is under-prescribed in patients with surgically treated acute myocardial infarction
2021, Interactive Cardiovascular and Thoracic Surgery