ArticleJournal of thoracic disease2026
Preoperative antiplatelet strategies and coronary artery bypass graft outcomes: bleeding and cardiovascular events in 41,696 patients with acute coronary syndrome.
Article in Journal of thoracic disease, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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9 authors.
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Abstract
Background: The aim of this study wasto evaluate the clinical effects of preoperative antiplatelet therapy (APT) discontinuation timing on major bleeding and adverse cardiac events in patients undergoing coronary artery bypass grafting (CABG). Methods: This retrospective cohort study analyzed data from Fuwai Cardiac Surgery Database (FCSD), specifically from 41,689 patients with acute coronary syndrome undergoing isolated CABG (2009-2019). A comparison was conducted between 10,739 patients treated with continuation APT (AP group; discontinued ≤7 days preoperation; including aspirin alone, clopidogrel alone, or aspirin + clopidogrel) and 30,950 patients with discontinuation therapy (NAP group; >7 days preoperation). Major bleeding events were defined according to the Bleeding Academic Research Consortium-CABG criteria. Composite adverse events (30-day all-cause mortality, stroke, myocardial infarction, and acute renal failure) were assessed. Multivariable logistic regression was applied to estimate effects. Results: Adverse cardiac events occurred in 7.8% of patients in the AP group and 9.1% in the NAP group (P<0.001), but there was no difference in the incidence of major bleeding events. Multivariable analysis showed that continuation therapy significantly decreased the risk of adverse cardiac events [odds ratio (OR) 0.832; 95% confidence interval (CI): 0.754-0.918; P<0.001] without increasing the risk of major bleeding events (OR 1.006; 95% CI: 0.926-1.093; P=0.88). Subgroup analysis identified certain strategies for reducing adverse events without bleeding. Conclusions: Preoperative continued APT significantly reduces the risk of 30-day adverse cardiac events post-CABG without increasing the risk of major bleeding. Optimal strategies include clopidogrel alone (discontinued <3 days preoperatively) and dual-antiplatelet therapy (aspirin + clopidogrel discontinued 5-7 days preoperatively).
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