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(Circulation. 2005;112:I-286 – I-292.)
© 2005 American Heart Association, Inc.

Surgery for Coronary Artery Disease

Preoperative Aspirin Therapy Is Associated With Improved Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Grafting

Kevin A. Bybee, MD; Brian D. Powell, MD; Uma Valeti, MD; A. Gabriela Rosales, MS; Stephen L. Kopecky, MD; Charles Mullany, MB, MS; R. Scott Wright, MD

From the Department of Internal Medicine (K.A.B., B.D.P., U.V., S.L.K., R.S.W.), and the Divisions of Cardiovascular Diseases (K.A.B., B.D.P., U.V., S.L.K., R.S.W.), Biostatistics (A.G.R.), and Cardiothoracic Surgery (C.M.), Mayo Clinic College of Medicine, Rochester, Minn.

Correspondence to Dr R. Scott Wright, Mayo Clinic and Foundation, Associate Professor of Medicine and Cardiology, Gonda 5-477, 200 First St SW, Rochester, MN 55905. E-mail wright.scott{at}mayo.edu

Background— Aspirin is beneficial in the setting of atherosclerotic cardiovascular disease. There are limited data evaluating preoperative aspirin administration preceding coronary artery bypass grafting and associated postoperative outcomes.

Methods and Results— Using prospectively collected data from 1636 consecutive patients undergoing first-time isolated coronary artery bypass surgery at our institution from January 2000 through December 2002, we evaluated the association between aspirin usage within the 5 days preceding coronary bypass surgery and risk of adverse in-hospital postoperative events. A logistic regression model, which included propensity scores, was used to adjust for remaining differences between groups. Overall, there were 36 deaths (2.2%) and 48 adverse cerebrovascular events (2.9%) in the postoperative hospitalization period. Patients receiving preoperative aspirin (n=1316) had significantly lower postoperative in-hospital mortality compared with those not receiving preoperative aspirin [1.7% versus 4.4%; adjusted odds ratio (OR), 0.34; 95% CI, 0.15 to 0.75; P=0.007]. Rates of postoperative cerebrovascular events were similar between groups (2.7% versus 3.8%; adjusted OR, 0.67; 95% CI, 0.32 to 1.50; P=0.31). Preoperative aspirin therapy was not associated with an increased risk of reoperation for bleeding (3.5% versus 3.4%; P=0.96) or requirement for postoperative blood product transfusion (adjusted OR, 1.17; 95% CI, 0.88 to 1.54; P=0.28).

Conclusions— Aspirin usage within the 5 days preceding coronary artery bypass surgery is associated with a lower risk of postoperative in-hospital mortality and appears to be safe without an associated increased risk of reoperation for bleeding or need for blood product transfusion.

Key Words: aspirin • surgery • cardiopulmonary bypass • mortality