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Original Article
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Volume 347:1309-1317 October 24, 2002 Number 17
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Aspirin and Mortality from Coronary Bypass Surgery
Dennis T. Mangano, Ph.D., M.D., for the Multicenter Study of Perioperative Ischemia Research Group

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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.


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From the Ischemia Research and Education Foundation, San Francisco.

Address reprint requests to Dr. Mangano at the Editorial Office, Ischemia Research and Education Foundation, 250 Executive Park Blvd., Ste. 3400, San Francisco, CA 94134, or at dtb{at}iref.org.

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Related Letters:

Aspirin and Mortality from Coronary Bypass Surgery
Chesebro J. H., Fuster V., Pugo F. J., Karzai W., Priebe H.-J., Mangano D. T.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:1057-1059, Mar 13, 2003. Correspondence

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