BACKGROUND: There is no therapy known to reduce the risk of complications or death after coronary bypass surgery. Because platelet activation constitutes a pivotal mechanism for injury in patients with atherosclerosis, we assessed whether early treatment with aspirin could improve survival after coronary bypass surgery. METHODS: At 70 centers in 17 countries, we prospectively studied 5065 patients undergoing coronary bypass surgery, of whom 5022 survived the first 48 hours after surgery. We gathered data on 7500 variables per patient and adjudicated outcomes centrally. The primary focus was to discern the relation between early aspirin use and fatal and nonfatal outcomes. RESULTS: During hospitalization, 164 patients died (3.2 percent), and 812 others (16.0 percent) had nonfatal cardiac, cerebral, renal, or gastrointestinal ischemic complications. Among patients who received aspirin (up to 650 mg) within 48 hours after revascularization, subsequent mortality was 1.3 percent (40 of 2999 patients), as compared with 4.0 percent among those who did not receive aspirin during this period (81 of 2023, P<0.001). Aspirin therapy was associated with a 48 percent reduction in the incidence of myocardial infarction (2.8 percent vs. 5.4 percent, P<0.001), a 50 percent reduction in the incidence of stroke (1.3 percent vs. 2.6 percent, P=0.01), a 74 percent reduction in the incidence of renal failure (0.9 percent vs. 3.4 percent, P<0.001), and a 62 percent reduction in the incidence of bowel infarction (0.3 percent vs. 0.8 percent, P=0.01). Multivariate analysis showed that no other factor or medication was independently associated with reduced rates of these outcomes and that the risk of hemorrhage, gastritis, infection, or impaired wound healing was not increased with aspirin use (odds ratio for these adverse events, 0.63; 95 percent confidence interval, 0.54 to 0.74). CONCLUSIONS: Early use of aspirin after coronary bypass surgery is safe and is associated with a reduced risk of death and ischemic complications involving the heart, brain, kidneys, and gastrointestinal tract.

Aspirin and mortality from coronary bypass surgery / D.T. Mangano, L. Saidman, J. Levin, P. Barash, C. Dietzel, A. Herskowitz, C. Ley, P. Hsu, D. Kardatzke, S. Wang, I.C. Tudor,D. Beatty, B. Xavier, S. Kerkela, S. Aronson, M. Comunale, M. D'Ambra, M. Eaton,R. Engelman, J. Fitch, K. Grichnik,C.B. Hantler, Z. Hillel, M. Kanchuger, J. Ostrowski, C.M. Mangano, J. Mathew, M. Fontes, P. Barash, M. McSweeney, R. Wolman, C.A. Napolitano, L.A. Nesbitt, N. Nijhawan, N. Nussmeier, E.G. Pivalizza, S. Polson, J. Ramsay, G. Roach, N. Schwann, S. Shenaq, K. Shevde, L. Shore-Lesserson, D. Bronheim, J. Wahr, B. Spiess, A. Wallace, H. Metzler, D. Ansley, J.P. O'Connor, D. Cheng, D. Cote, P. Duke, J.Y. Dupuis, M. Hynes, B.Finnegan, R. Martineau, P. Couture, D. Mazer, J.C. Villalba, M.E. Colmenares, C. Girard, C. Isetta, C.A. Greim, N. Roewer, A. Hoeft, R. Loeb, J. Radke, T. Mollhoff, J. Motsch, E. Martin, E. Ott, P. Ueberfuhr, J. Scholz, P. Tonner, H. Sonntag, A. Szekely, R. Juneja, G. Mani, E. Siregar, B. Drenger, Y.Gozal, E. Elami, C. Tommasino, P. Luna, P. Roekaerts, S. DeLange, R. Pfitzner, D. Filipescu, U. Prakanrattana, D.J.R. Duthie, R.O. Feneck, M.A. Fox, J.D. Park, D. Smith, A. Vohra, A. Vuylsteke, R.D. Latimer. - In: NEW ENGLAND JOURNAL OF MEDICINE. - ISSN 0028-4793. - 347:17(2002 Oct 24), pp. 1309-1317.

Aspirin and mortality from coronary bypass surgery

C. Tommasino;
2002-10-24

Abstract

BACKGROUND: There is no therapy known to reduce the risk of complications or death after coronary bypass surgery. Because platelet activation constitutes a pivotal mechanism for injury in patients with atherosclerosis, we assessed whether early treatment with aspirin could improve survival after coronary bypass surgery. METHODS: At 70 centers in 17 countries, we prospectively studied 5065 patients undergoing coronary bypass surgery, of whom 5022 survived the first 48 hours after surgery. We gathered data on 7500 variables per patient and adjudicated outcomes centrally. The primary focus was to discern the relation between early aspirin use and fatal and nonfatal outcomes. RESULTS: During hospitalization, 164 patients died (3.2 percent), and 812 others (16.0 percent) had nonfatal cardiac, cerebral, renal, or gastrointestinal ischemic complications. Among patients who received aspirin (up to 650 mg) within 48 hours after revascularization, subsequent mortality was 1.3 percent (40 of 2999 patients), as compared with 4.0 percent among those who did not receive aspirin during this period (81 of 2023, P<0.001). Aspirin therapy was associated with a 48 percent reduction in the incidence of myocardial infarction (2.8 percent vs. 5.4 percent, P<0.001), a 50 percent reduction in the incidence of stroke (1.3 percent vs. 2.6 percent, P=0.01), a 74 percent reduction in the incidence of renal failure (0.9 percent vs. 3.4 percent, P<0.001), and a 62 percent reduction in the incidence of bowel infarction (0.3 percent vs. 0.8 percent, P=0.01). Multivariate analysis showed that no other factor or medication was independently associated with reduced rates of these outcomes and that the risk of hemorrhage, gastritis, infection, or impaired wound healing was not increased with aspirin use (odds ratio for these adverse events, 0.63; 95 percent confidence interval, 0.54 to 0.74). CONCLUSIONS: Early use of aspirin after coronary bypass surgery is safe and is associated with a reduced risk of death and ischemic complications involving the heart, brain, kidneys, and gastrointestinal tract.
vein-graft patency; cardiopulmonary bypass; myocardial-ischemia; cardiovascular morbidity; noncardiac surgery; revascularization; association; platelet; dysfunction; cardioplegia
Settore MED/41 - Anestesiologia
NEW ENGLAND JOURNAL OF MEDICINE
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/66545
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