Aspirin in coronary artery surgery

1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial

Paul S. Myles, Julian A. Smith, Jessica Kasza, Brendan Silbert, Mohandas Jayarajah, Thomas Painter, D. James Cooper, Silvana Marasco, John McNeil, Jean S. Bussières, Shay McGuinness, Matthew T. V. Chan, Sophie Wallace, Andrew Forbes, for the ATACAS investigators and the ANZCA Clinical Trials Network

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery. Results: Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P =.48). There was no significant difference in the rates of myocardial infarction (P =.11), stroke (P =.086), or death (P =.24), or a composite of these cardiovascular end points (P =.68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P =.03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P >.10). Conclusions: In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.
Original languageEnglish
Pages (from-to)633-640
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number2
DOIs
Publication statusPublished - Feb 2019

Keywords

  • anesthesia
  • antiplatelet
  • disability-free survival
  • major adverse cardiac events
  • outcome

Cite this

Myles, Paul S. ; Smith, Julian A. ; Kasza, Jessica ; Silbert, Brendan ; Jayarajah, Mohandas ; Painter, Thomas ; Cooper, D. James ; Marasco, Silvana ; McNeil, John ; Bussières, Jean S. ; McGuinness, Shay ; Chan, Matthew T. V. ; Wallace, Sophie ; Forbes, Andrew ; for the ATACAS investigators and the ANZCA Clinical Trials Network. / Aspirin in coronary artery surgery : 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial. In: Journal of Thoracic and Cardiovascular Surgery. 2019 ; Vol. 157, No. 2. pp. 633-640.
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title = "Aspirin in coronary artery surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial",
abstract = "Background: Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery. Results: Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1{\%} in the aspirin group and 3.5{\%} in the placebo group (relative risk, 1.17; 95{\%} confidence interval, 0.76-1.81; P =.48). There was no significant difference in the rates of myocardial infarction (P =.11), stroke (P =.086), or death (P =.24), or a composite of these cardiovascular end points (P =.68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P =.03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P >.10). Conclusions: In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.",
keywords = "anesthesia, antiplatelet, disability-free survival, major adverse cardiac events, outcome",
author = "Myles, {Paul S.} and Smith, {Julian A.} and Jessica Kasza and Brendan Silbert and Mohandas Jayarajah and Thomas Painter and Cooper, {D. James} and Silvana Marasco and John McNeil and Bussi{\`e}res, {Jean S.} and Shay McGuinness and Chan, {Matthew T. V.} and Sophie Wallace and Andrew Forbes and {for the ATACAS investigators and the ANZCA Clinical Trials Network}",
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Aspirin in coronary artery surgery : 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial. / Myles, Paul S.; Smith, Julian A.; Kasza, Jessica; Silbert, Brendan; Jayarajah, Mohandas; Painter, Thomas; Cooper, D. James; Marasco, Silvana; McNeil, John; Bussières, Jean S.; McGuinness, Shay; Chan, Matthew T. V.; Wallace, Sophie; Forbes, Andrew; for the ATACAS investigators and the ANZCA Clinical Trials Network.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 157, No. 2, 02.2019, p. 633-640.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Aspirin in coronary artery surgery

T2 - 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial

AU - Myles, Paul S.

AU - Smith, Julian A.

AU - Kasza, Jessica

AU - Silbert, Brendan

AU - Jayarajah, Mohandas

AU - Painter, Thomas

AU - Cooper, D. James

AU - Marasco, Silvana

AU - McNeil, John

AU - Bussières, Jean S.

AU - McGuinness, Shay

AU - Chan, Matthew T. V.

AU - Wallace, Sophie

AU - Forbes, Andrew

AU - for the ATACAS investigators and the ANZCA Clinical Trials Network

PY - 2019/2

Y1 - 2019/2

N2 - Background: Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery. Results: Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P =.48). There was no significant difference in the rates of myocardial infarction (P =.11), stroke (P =.086), or death (P =.24), or a composite of these cardiovascular end points (P =.68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P =.03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P >.10). Conclusions: In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.

AB - Background: Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival. Methods: Using a factorial design, we randomly assigned patients undergoing coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery. Results: Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate of death or severe disability was 4.1% in the aspirin group and 3.5% in the placebo group (relative risk, 1.17; 95% confidence interval, 0.76-1.81; P =.48). There was no significant difference in the rates of myocardial infarction (P =.11), stroke (P =.086), or death (P =.24), or a composite of these cardiovascular end points (P =.68). With the exception of those with a low European System for Cardiac Operative Risk Evaluation score (P =.03), there were no interaction effects on these outcomes with tranexamic acid (all tests of interaction P >.10). Conclusions: In patients undergoing coronary artery surgery, preoperative aspirin did not reduce death or severe disability, or thrombotic events through to 1 year after surgery.

KW - anesthesia

KW - antiplatelet

KW - disability-free survival

KW - major adverse cardiac events

KW - outcome

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DO - 10.1016/j.jtcvs.2018.08.114

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