Safety of Perioperative Aprotinin Administration During Isolated Coronary Artery Bypass Graft Surgery: Insights From the ART (Arterial Revascularization Trial)

Medientyp: E-Artikel
Titel: Safety of Perioperative Aprotinin Administration During Isolated Coronary Artery Bypass Graft Surgery: Insights From the ART (Arterial Revascularization Trial)
Beteiligte: Benedetto, Umberto; Altman, Douglas G.; Gerry, Stephen; Gray, Alastair; Lees, Belinda; Angelini, Gianni D.; Flather, Marcus; Taggart, David P.; Ratnatunga, C.; Westaby, S.; Cook, J.; Wallis, C.; Wos, S.; Jasinski, M.; Widenka, K.; Blach, A.; Gocol, R.; Hudziak, D.; Zurek, P.; Deja, M.; Bachowski, R.; Mrozek, R.; Kargul, T.; Domarardzki, W.; [...]
Erschienen: Ovid Technologies (Wolters Kluwer Health), 2018
Erschienen in: Journal of the American Heart Association
Sprache: Englisch
DOI: 10.1161/jaha.117.007570
ISSN: 2047-9980
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Beschreibung: <jats:sec xml:lang="en"><jats:title>Background</jats:title><jats:p xml:lang="en">There is still uncertainty about the safety of aprotinin for coronary artery bypass graft surgery. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral versus single internal thoracic artery grafting. Many of the<jats:styled-content style="fixed-case">ART</jats:styled-content>patients (≈30%) received perioperative aprotinin. We investigated the association between perioperative aprotinin administration and short‐term (in‐hospital) and long‐term outcomes by performing a post hoc analysis of the<jats:styled-content style="fixed-case">ART</jats:styled-content>.</jats:p></jats:sec><jats:sec xml:lang="en"><jats:title>Methods and Results</jats:title><jats:p xml:lang="en">Among patients enrolled in the<jats:styled-content style="fixed-case">ART</jats:styled-content>(n=3102) from 2004 to 2007, we excluded those who did not undergo surgery (n=18) and those with no information about use of perioperative aprotinin (n=9). Finally, 836 of 3076 patients (27%) received aprotinin. Propensity matching was used to select 536 pairs for final comparison. Aprotinin was also associated with an increased risk of hospital mortality (9 [1.7%] versus 1 [0.2%]; odds ratio, 9.12; 95% confidence interval [CI], 1.15–72.2;<jats:italic>P</jats:italic>=0.03), intra‐aortic balloon pump insertion (37 [6.9%] versus 17 [3.2%]; odds ratio, 2.26; 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>, 1.26–4.07;<jats:italic>P</jats:italic>=0.006), and acute kidney injury (102 [19.0%] versus 76 [14.2%]; odds ratio, 1.42; 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>, 1.03–1.97;<jats:italic>P</jats:italic>=0.03). Aprotinin was not associated with a lower incidence of transfusion (37 [6.9%] versus 28 [5.2%]; odds ratio, 1.34; 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>, 0.81–2.23;<jats:italic>P</jats:italic>=0.25) and reexploration (26 [4.9%] versus 19 [3.5%]; hazard ratio, 1.39; 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>, 0.76–2.53;<jats:italic>P</jats:italic>=0.28). At 5 years, all‐cause mortality was significantly increased in the aprotinin group (56 [10.6%] versus 38 [7.3%]; hazard ratio, 1.51; 95%<jats:styled-content style="fixed-case">CI</jats:styled-content>, 1.0–2.28;<jats:italic>P</jats:italic>=0.045).</jats:p></jats:sec><jats:sec xml:lang="en"><jats:title>Conclusions</jats:title><jats:p xml:lang="en">In the present post hoc<jats:styled-content style="fixed-case">ART</jats:styled-content>analysis, aprotinin was associated with a significantly increased risk of early and late mortality.</jats:p></jats:sec><jats:sec xml:lang="en"><jats:title>Clinical Trial Registration</jats:title><jats:p xml:lang="en"><jats:styled-content style="fixed-case">URL</jats:styled-content>:<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.isrctn.com">http://www.isrctn.com</jats:ext-link>. Unique identifier:<jats:styled-content style="fixed-case">ISRCTN</jats:styled-content>46552265.</jats:p></jats:sec>
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