Background and Goal of Study: The effects of preoperative aspirin on major cardiocerebral and renal outcomes and mortality remain uncertain.
Materials and Methods: A multicenter/retrospective cohort study was performed on consecutive patients (n= 4256) receiving cardiac surgery (most were for CABG or/and valve surgery) in two university medical centers in the United States from 2001 to 2009. The patients excluded were those with preoperative anticoagulants, ADP inhibitors, Gp IIbIIIa inhibitors, antiplatelets or unknown aspirin use. Primary outcomes included 30-day mortality, renal failure and a composite outcome - major adverse cardiocerebral events (MACE) that included permanent or transient stroke, coma, perioperative myocardial infarction (MI), heart block and cardiac arrest.
Results and Discussion: Of all patients, 2868 patients met the inclusion criteria and were divided into two groups: those taking (n=1923) or not taking (n=945) aspirin within 5 days preceding surgery. The groups did not differ significantly in baseline parameters including body mass index, smoking, congestive heart failure and intra-operative cross-clamping time. Patients in the aspirin group had significantly more with history of hypertension, diabetes, peripheral arterial disease, previous MI, angina, cerebrovascular disease, chronic lung disease, older age and male gender; also were associated with more preoperative using beta-blockers and rennin-angiotensin system inhibitors, and more left main and multiple coronary artery disease, but spent less time in bypass perfusion. With propensity scores adjusted and multivariate logistic regression, however, the results of this study showed that preoperative use of aspirin significantly reduced the incidence of MACE (8.7% incidence in the aspirin group vs. 10.8% in the non-aspirin group, adjusted odds ratio [OR]: 0.662, 95% confidence interval [CI]: 0.482-0.909, P=0.011), postoperative renal failure (3.7% vs. 7.1%, OR 0.384, 95% CI 0.254-0.579, P< 0.001), and 30-day mortality (3.5% vs. 6.5%, OR 0.611, 95% CI 0.391-0.956, P=0.031) in the patients undergoing cardiac surgery.
However, 30-day readmission and intensive care unit stay did not show a significant difference between two groups.
Conclusion(s): The results of this study showed that preoperative therapy of aspirin significantly reduced major cardiocerebral complications, renal failure and 30-day mortality in patients undergoing cardiac surgery.