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International Society For Minimally Invasive Cardiothoracic Surgery

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Dual Antiplatelet Therapy As A Predictor Of Macce In Robotically Assisted Minimally Invasive Direct Coronary Artery Bypass
Jef Van den Eynde1, Luna Snelders1, Herbert De Praetere1, Mark Coosemans2, Nick Hiltrop3, Johan Bennett1, Steven Jacobs1, Wouter Oosterlinck1.
1KU Leuven, Leuven, Belgium, 2UZ Turnhout, Turnhout, Belgium, 3AZ Groeninge, Kortrijk, Belgium.

BACKGROUND - Dual antiplatelet therapy (DAPT) combining aspirin and a P2Y12 receptor inhibitor have been shown beneficial in patients with acute coronary syndrome or those undergoing PCI. It is currently unclear whether DAPT use should be a concern in hybrid procedures. The aim of this study was to evaluate the effect of DAPT use on outcomes and complications after RA-MIDCAB. METHODS - Data from 249 patients who underwent RA-MIDCAB surgery at the University Hospitalis of Leuven between July 2015 and June 2019 were reviewed. One group (n = 65, median age 63 (58-74)) received DAPT [DAPT], the other (n = 182, median age 68 (60-74)) did not [non-DAPT]. Hospital stay, hemoglobin change, peak troponin, total drainage, complications, MACCE-free survival, and graft failure were compared between the two groups. Data are presented as mean SD, median (IQR), or n (%). RESULTS - Patients in the DAPT group had more often had a recent AMI (33.3% vs 19.0%, p=0.019) and previous PCI (76.9% vs 29.3%, p<0.001), and were more often included in a hybrid procedure (58.5% vs 17.4%, p<0.001). Hemoglobin change was significantly larger in patients on DAPT (-1.80 [-2.55 - -1.00] vs -1.50 [-2.18 - -0.80]g/dl, p=0.033). There was no difference with regard to hospital stay, peak troponin, total drainage, overall complications, or graft failure. Patients in the DAPT group showed significantly worse 1-year MACCE-free survival (Figure 1), mainly driven by higher rates of MI (2 (3.1%) vs 0 (0%), p=0.017) and repeat vascularization (2 (3.1%) vs 0 (0%), p=0.017). Cox regression of MACCE revealed an OR of 3.74 (1.13-12.36, p=0.030) for DAPT use, whereas the contributions of recent AMI, previous PCI, or hybrid were not significant. Reintervention for bleeding was similar between groups (0% vs 1.6%, p=0.300). CONCLUSIONS - Patients on DAPT had worse MACCE-free survival after RA-MIDCAB, independent of recent AMI, previous PCI, or hybrid revascularization. These results suggest that the use of DAPT in the context of hybrid in itself is not associated with worse outcomes, but that DAPT in patients who are already taking it for a longer time, might be an indicator of more severe coronary artery disease.


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