Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients

doi:10.1016/S0003-4975(00)02133-0

The Annals of Thoracic Surgery

Volume 70, Issue 6, December 2000, Pages 1986-1990

https://doi.org/10.1016/S0003-4975(00)02133-0 Get rights and content

Abstract

Background. Discontinuing aspirin use in patients before coronary artery bypass grafting (CABG) has focused on bleeding risks. The effect of aspirin use on overall mortality with this procedure has not been studied.

Methods. We performed a case patient–control patient study of the 8,641 consecutive isolated CABG procedures performed between July 1987 and May 1991 in Maine, New Hampshire, and Vermont. Patients included all 368 deaths. Each case patient was paired with approximately two matched survivors (control patients). Aspirin use was defined by identification of ingestion within 7 days before the operation.

Results. CABG patients using preoperative aspirin were less likely to experience in-hospital mortality in univariate (odds ratio [OR] = 0.73, 95% confidence interval [0.54, 0.97]) and multivariate [OR = 0.55, (0.31, 0.98)] analysis compared to nonusers. No significant difference was seen in the amount of chest tube drainage, transfusion of blood products, or need for reexploration for hemorrhage between patients who did and did not receive aspirin.

Conclusions. Preoperative aspirin use appears to be associated with a decreased risk of mortality in CABG patients without significant increase in hemorrhage, blood product requirements, or related morbidities.

Section snippets

Setting

The Northern New England Cardiovascular Disease Study Group is a voluntary research consortium representing all five medical centers in Maine, New Hampshire and Vermont where CABG operations are performed. Since 1987, the Northern New England Cardiovascular Disease Study Group has maintained a prospective registry of all patients undergoing cardiac operations in the region.

Study design

This was a multicenter case patients and control patients study of in-hospital survivors and nonsurvivors of CABG between

Patient characteristics

Baseline patient characteristics of the case patients and the matched control patients were evaluated. Case patients and control patients were similar with respect to history of chronic obstructive pulmonary disease, smoking, prior CABG operations, left ventricular end diastolic pressure, and the variables matched on (age, sex, and priority). However, patients who had hypertension, peripheral vascular disease, a higher preoperative creatinine, history of diabetes, higher Charlson comorbidity

Comment

In this study, preoperative aspirin use by patients undergoing isolated CABG was associated with a 27% reduction in in-hospital mortality. This reduction in mortality persisted (45%) when adjusted for severity of disease and comorbid factors, and appeared to have a greater effect in women than in men. A similar reduction in mortality was reported in the results of The Society of Thoracic Surgeons National Database [10]. Using multivariate analysis, the authors found a 30% reduction (OR = 0.70, p

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Original article: cardiovascularEffect of preoperative aspirin use on mortality in coronary artery bypass grafting patients

Abstract

Section snippets

Setting

Study design

Patient characteristics

Comment

J Am Coll Cardiol

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Cardiothorac Vasc Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

J Surg Res

Original article: cardiovascular
Effect of preoperative aspirin use on mortality in coronary artery bypass grafting patients