Original article
Adult cardiac
Effects of Aprotinin on Short-Term and Long-Term Outcomes After Coronary Artery Bypass Grafting Surgery

https://doi.org/10.1016/j.athoracsur.2010.02.006Get rights and content

Background

Recent studies demonstrated that aprotinin use would increase the short-term and long-term mortality and complications after coronary artery bypass grafting (CABG). This study was to investigate effects of aprotinin during isolated primary CABG on short-term and long-term outcomes in Chinese patients.

Methods

We studied 5,103 consecutive Chinese patients who underwent isolated primary CABG from 1999 to 2005. Of all the patients, 4,122 received aprotinin during operation (aprotinin group) and 981 received no aprotinin or other antifibrinolytic therapy (control group). Short-term and long-term mortality and major complications were analyzed with multivariate regression analysis. Propensity adjustment method was used to minimize the selection bias between the two groups, and propensity matching method was used to yield two well-matched groups for further comparison.

Results

Blood loss after operation was significantly reduced in the aprotinin group compared with the control group (p < 0.001). Aprotinin use was neither associated with the perioperative mortality (p = 0.45, relative risk, 1.34) or major complications, nor was it associated with long-term mortality (p = 0.21, relative risk, 1.26) and major adverse cardiac and cerebrovascular events (p = 0.82, relative risk, 0.98). After propensity adjustment for the baseline characteristics, we obtained similar results. In addition, comparison between the two well-matched groups showed no significant difference either in baseline characteristics or in short-term and long-term outcomes.

Conclusions

Aprotinin use during isolated primary CABG reduced blood loss significantly, but was not associated with short-term or long-term mortality and complications. Aprotinin use in relatively low-risk CABG patients was effective and safe in a Chinese (Asian) population.

Section snippets

Study Design

This was a retrospective, observational study of consecutive patients who underwent isolated primary CABG at the Fuwai Hospital. The study protocol was approved by the the Ethics Committee of Fuwai Hospital, and a waiver of the requirement of written informed consent was obtained.

Study Population

From January 1999 to December 2005, data of 5,559 consecutive patients undergoing CABG at Fuwai hospital, Beijing, China were prospectively entered into a surgical database. Data were extracted for 5,103 patients who

Baseline Characteristics

The comparison of baseline characteristics between the aprotinin group and control group showed some significant differences. But there were no significant differences between the two groups after propensity adjustment (Table 1).

Perioperative Outcomes

Blood loss after operation was significantly reduced in the aprotinin group as compared with that in the control group (462.4 ± 251.7 vs 739.5 ± 342.4, p < 0.001). Application of aprotinin was not associated with the perioperative mortality (1.2% vs 1.0%, p = 0.57) or

Comment

In the present study, Chinese patients, as the sample from the Asian population, were investigated to show whether the adverse effect mentioned by the above studies would happen after receiving aprotinin during isolated primary CABG. In our findings, aprotinin could significantly reduce blood loss but was not associated with the risk of short-term or long-term mortality and complications, including renal, cerebrovascular, and cardiovascular adverse events.

The mechanisms of aprotinin have been

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    The first two authors contributed equally to this paper.

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