Effect of Preoperatively Continued Aspirin Use on Early and Mid-Term Outcomes in Off-Pump Coronary Bypass Surgery: A Propensity Score-Matched Study of 1418 Patients
Effect of Preoperatively Continued Aspirin Use on Early and Mid-Term Outcomes in Off-Pump Coronary Bypass Surgery: A Propensity Score-Matched Study of 1418 Patients
复制标题
DOI：
10.1371/journal.pone.0116311
复制
发表时间：
2015-02-23
期刊：
影响因子：
3.7
通讯作者：
Song, Yunhu
中科院分区：
文献类型：
--
作者：
Xiao, Fucheng;Wu, Hengchao;Song, Yunhu
背景：目前，对非体外循环冠状动脉旁路移植术（CABG）术前持续服用阿司匹林的效果了解较少。我们的目的是评估术前持续使用阿司匹林对接受非体外循环冠状动脉旁路移植术（CABG）患者的早期和中期结局的影响。MethodsFrom 2009年10月至2013年9月，阜外医院将709名术前阿司匹林使用者与唯一的709名非阿司匹林使用者进行匹配，使用倾向评分匹配，以获得两组之间的风险调整结局比较。早期结局为院内死亡、卒中、术中和术后失血、出血再手术和血液制品输注。主要不良心脏事件（死亡，心肌梗死或重复血运重建），心绞痛复发和心源性再入院被认为是中期endpoints.ResultsThere基线特征后，倾向评分匹配组间无显着差异。术中失血量中位数（600 ml vs 450 ml，P = 0.56），中位术后失血量（800 ml vs 790 ml，P = 0.60），输血要求（25.1% vs 24.4%，P = 0.76）和院内死亡、卒中和因出血再次手术的复合结局（2.8%对1.6%，P = 0.10）在阿司匹林和非阿司匹林使用组中相似。在大约4年的随访中，没有观察到阿司匹林和非阿司匹林使用组在无主要不良心脏事件生存率估计方面的显著差异（95.7% vs 91.5%，P = 0.23）和无心源性再入院（88.5%vs85.3%，P = 0.77）而无心绞痛复发生存率在阿司匹林组和非阿司匹林组分别为83.7%和73.9（P = 0.02），术前阿司匹林的比值比估计为0.71（95%可信区间，0.49-1.04，P = 0.08）.结论术前持续使用阿司匹林与术中和术后失血风险增加无关，非体外循环冠状动脉旁路移植术中的输血需求和院内死亡、卒中和出血再手术的复合结局。术前使用阿司匹林倾向于降低中期心绞痛复发的风险。
BackgroundTo date, effect of preoperatively continued aspirin administration in off-pump coronary artery bypass grafting (CABG) is less known. We aimed to assess the effect of preoperatively continued aspirin use on early and mid-term outcomes in patients receiving off-pump CABG.MethodsFrom October 2009 to September 2013 at the Fuwai Hospital, 709 preoperative aspirin users were matched with unique 709 nonaspirin users using propensity score matching to obtain risk-adjusted outcome comparisons between the two groups. Early outcomes were in-hospital death, stroke, intra- and post-operative blood loss, reoperation for bleeding and blood product transfusion. Major adverse cardiac events (death, myocardial infarction or repeat revascularization), angina recurrence and cardiogenic readmission were considered as mid-term endpoints.ResultsThere were no significant differences among the groups in baseline characteristics after propensity score matching. The median intraoperative blood loss (600 ml versus 450 ml, P = 0.56), median postoperative blood loss (800 ml versus 790 ml, P = 0.60), blood transfusion requirements (25.1% versus 24.4%, P = 0.76) and composite outcome of in-hospital death, stroke and reoperation for bleeding (2.8% versus 1.6%, P = 0.10) were similar in aspirin and nonaspirin use group. At about 4 years follow-up, no significant difference was observed among the aspirin and nonaspirin use group in major adverse cardiac events free survival estimates (95.7% versus 91.5%, P = 0.23) and freedom from cardiogenic readmission (88.5% versus 85.3%, P = 0.77) whereas the angina recurrence free survival rates was 83.7% and 73.9% in the aspirin and nonaspirin use group respectively (P = 0.02), with odd ratio for preoperative aspirin estimated at 0.71 (95% confidence interval, 0.49-1.04, P = 0.08).ConclusionsPreoperatively continued aspirin use was not associated with increased risk of intra- and post-operative blood loss, blood transfusion requirements and composite outcome of in-hospital death, stroke and reoperation for bleeding in off-pump CABG. Preoperative aspirin use tended to decrease the hazard of mid-term angina recurrence.