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Dai Une
Department Kawasaki Medical School Kawasaki Medical School, Department of Cardiovascular Surgery, Position Professor |
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| Article types | 原著 |
| Language | English |
| Peer review | Peer reviewed |
| Title | Impact of clopidogrel plus aspirin versus aspirin alone on the progression of native coronary artery disease after bypass surgery: analysis from the Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) randomized trial. |
| Journal | Formal name：Circulation Abbreviation：Circulation ISSN code：15244539/00097322 |
| Domestic / Foregin | Foregin |
| Volume, Issue, Page | 130(11 Suppl 1),pp.S12-8 |
| Author and coauthor | Dai Une, Talal Al-Atassi, Alexander Kulik, Pierre Voisine, Michel Le May, Marc Ruel |
| Authorship | Lead author |
| Publication date | 2014/09 |
| Summary | BACKGROUND:The effects of dual antiplatelet therapy with aspirin and clopidogrel on the progression of native coronary artery disease after coronary artery bypass grafting are unknown.METHODS AND RESULTS:In the Clopidogrel After Surgery for Coronary Artery DiseasE (CASCADE) trial, a total of 113 patients were randomized to receive aspirin plus clopidogrel or aspirin plus placebo for 1 year after coronary artery bypass grafting. In this secondary analysis, the 92 patients who underwent preoperative and 1-year postoperative angiograms at 2 centers had each of their coronary stenoses graded serially by using 6 thresholds (grade 0 [0%-24%], grade 1 [25%-37%], grade 2 [38%-62%], grade 3 [63%-82%], grade 4 [83%-98%], and grade 5 [99%-100%]). We compared the incidence and degree of evolving coronary artery disease between the 2 treatment groups. A total of 543 preoperative stenoses and occlusions were quantified and followed. At 1-year postoperatively, there were 103 evolving (94 worsened, 9 improved) and 22 new lesions. The right coronary artery territory and sites proximal to a graft were more commonly associated with worsening coronary artery disease (P≤0.02). There were no differences in clinical events between treatment groups, and the proportion of patients with evolving or new lesions was also similar (70% versus 74%, aspirin-clopidogrel versus aspirin-placebo, respectively; P=0.8). However, in evolving or new lesions, the mean grade change (1.1±1.0 versus 1.6±1.1, respectively; P=0.01) and the proportion of new occlusions (7% versus 22%; P=0.02) were lower in the aspirin-clopidogrel group.CONCLUSIONS:The addition of clopidogrel to aspirin correlates with less worsening of native coronary artery disease 1 year after coronary artery bypass grafting. These findings may help guide post-coronary artery bypass grafting antiplatelet therapy.CLINICAL TRIAL REGISTRATION URL:http://www.clinicaltrials.gov. Unique identifier: NCT00228423. |
| DOI | 10.1161/CIRCULATIONAHA.113.008227 |
| PMID | 25200049 |