Benedetto U, et al. - This post hoc analysis of the Arterial Revascularization Trial (ART) investigated the impact of dual antiplatelet therapy (DAPT) (with clopidogrel) post- coronary artery bypass grafting (CABG) on 1-year outcomes. Following CABG, no significant reduction in adverse cardiac and cerebrovascular events was observed at 1st postoperative year in patients who were discharged on DAPT with clopidogrel, compared with aspirin alone.

Methods

• Among participants of the ART (n = 3102), 609 (21%) and 2308 (79%) were discharged on DAPT or aspirin alone, respectively.
• The primary end-point was the incidence of major adverse cerebrovascular and cardiac events (MACCE) at 1 year including cardiac death, myocardial infarction, cerebrovascular accident and reintervention; safety end-point was bleeding requiring hospitalization.
• To create comparable groups, propensity score (PS) matching was used.

Results

• Findings demonstrated that among 609 PS-matched pairs, MACCE occurred in 34 (5.6%) and 34 (5.6%) in the DAPT and aspirin alone groups, respectively, with no significant difference between the 2 groups [hazard ratio (HR) 0.97, 95% confidence interval (CI) 0.59–1.59; P = 0.90].
• Data also reported that only 188 (31%) subjects completed 1 year of DAPT, and in this subgroup, MACCE rate was 5.8% (HR 1.11, 95% CI 0.53–2.30; P = 0.78).
• Researchers observed that in the overall sample, bleeding rate was higher in DAPT group (2.3% vs 1.1%; P = 0.02), although this difference was no longer significant after matching (2.3% vs 1.8%; P = 0.54).