Effect Of Various Anti-platelet Therapeutic Strategy On Graft Patency Following Off-pump Coronary Revascularization Surgery

Objective:Prospective randomized trial to compare the effect of three various anti-platelet therapic strategies of aspirin plus clopidogrel versus clopidogred and aspirin alone on grafts patency at 3 months,1 year and 2 years after off-pump coronary artery bypass grafting (OPCAB).Methods:From August 2007 to December 2010,180 patients undergoing elective OPCABG were randomly enrolled to 3 groups, with 60 cases in each group according to various anti-platelet therapic strategies:Group A received aspirin (100 mg) alone daily; Group C received clopidogrel (75 mg) alone; Group AC received aspirin plus clopidogrel (75 mg) daily. Antiplatelet therapies were initiated in 24 hours after operation. All participants were invited for clinical follow-up at 3 months,1 year and 2 years post-operatively.64-slice multislice computed tomography angiography (MSCTA) was used to evaluate graft patency.Results:No participants died after surgery, average time of follow-up were 3.2±2.1, 12.5±2.3 and 24.7±1.4 months. Of the 180 anticipants,161 (89.4%) finished 2 years follow-up.1. In 3 months follow-up post-operatively, LIMA grafts patency rate in three groups(A, C and AC), with arithmetic method of Fitzgibbon A+B, were 96.1%, 98.1% and 98.1% respectively. There were no significant differences (P>0.05) in LIMA grafts, neither in SVGs with the patency rate of 96.8%,95.8% and 97.9%.2. The result from 12 and 24 months follow-up showed the patency rate of LIMA grafts for Group A were 94.2% and 92.3%,94.5% for Group C as well as 96.3% and 94.4% for Group AC, and there were no significant differences. SVGs patency with arithmetic method of Fitzgibbon A+B in Group A were 92.4% and 90.3%,94.5% and 93.7% in Group C,96.0% and 94.9% in Group AC, and there were no significant differences. Conclusion:1. In 3 months,1 year and 2 years follow-up, three anti-platelet therapeutic strategies are no significant differences in LIMA grafts patency (Fitzgibbon A+B).2. In 3 months,1 year and 2 years follow-up, there are no significant difference for SVG grafts patency rate. Although there are no significant statistical differences(Fitzgibbon A+B) in three groups, yet the trend of SVG patency in Aspirin plus Clopidogrel is higher than Aspirin and Clopidgrel alone. Further investgation is advised.