Abstract 11546: Preoperative Aspirin in Coronary Artery Bypass Grafting: A Retrospective Analysis of 45666 Cases From Nationwide Japanese Surgical Database

Introduction:Controversies still exist in the literature regarding the effectiveness of preoperative aspirin use in providing survival and safety advantages in coronary artery bypass grafting (CABG). While recommended in international guidelines, its use is frequently avoided mainly due to concerns for peri-procedural bleeding complications. We aimed to assess the association between pre-CABG aspirin use and risk of death, and operative complications in real-world surgical practice in Japan.Methods:We selected patients >17 years old, undergoing elective CABG from Japan Cardiovascular Surgery Database 2013-16. We defined the treatment group as those receiving preoperative aspirin, other antiplatelets or anticoagulants, and no-treatment group as those not. We constructed a propensity score (PS) model for treatment from patient demographics, comorbidities and surgical conditions, as well as hospital CABG volume. After matching on PS with a standard caliper, we compared the incidences of 30 day or inhospital mortality, postoperative stroke, myocardial infarction (MI) and reoperation for bleed between the 2 groups. We repeated the analysis in a subgroup with history of percutaneous coronary intervention (PCI).Results:Among 45,666 patients treated at 578 facilities, 19,792 (43.3%) had received antiplatelet / anticoagulant preoperatively. 77.5% received aspirin-alone, and 17.8% received anticoagulants without aspirin. The treatment group had higher frequencies of off-pump procedure, acute coronary syndrome, history of PCI and 3-vessel disease. Among 14,149 PS-matched pairs, death occurred in 241 (1.7%) in no-treatment group and 204 (1.4%) in treatment group (p-value 0.08). Differences in the incidences of stroke (1.3% vs. 1.4%), MI (0.8% vs. 0.7%) and reoperation for bleed (1.5% vs. 1.3%) were all insubstantial. The result among the 5164 matched patients with history of PCI was similar, with no statistically significant difference in any of the outcomes.Conclusions:In a nationwide cardiovascular surgery database in Japan, preoperative antiplatelet / anticoagulant treatment was not associated with the risk of short-term mortality or morbidity. CABG was performed safely both with and without preoperative aspirin in Japan.