Abstract 10881: Mortality Benefit with Prasugrel in TRITON – TIMI 38 Coronary Artery Bypass Grafting (CABG) Cohort: Risk Adjusted Retrospective Data Analysis
A cohort of 422 patients undergoing isolated CABG in TRITON-TIMI 38 (PRASugrel n=208; CLOPidogrel n=214) was analyzed to characterize the outcomes of subjects related to timing of study drug withdrawal prior to CABG. Patients who never received study drug (N=56) or who received open label thienopyridine (N=20) treatment prior to CABG were excluded. A significantly lower mortality was observed in the PRAS cohort, see Figure 1. Overall all-cause mortality was 2.31% in the PRAS cohort compared to 8.67% in the CLOP cohort, with a hazard ratio of 0.26 (Log-rank p=0.016). Mortality was similar (3/16 PRAS, 3/14 CLOP) when CABG was performed before study drug was discontinued, but lower when study drug was discontinued for 1 or more days (1/156 PRAS vs 12/158 CLOP). There were no deaths (0/72) in PRAS patients having CABG with 1 to 5 days of drug withdrawal and 6 deaths in CLOP patients having CABG (6/85). The mortality risk at 30-days adjusted for possible imbalances at CABG baseline when analyzed by logistic regression per EURO scoring (p=0.024) remained statistically significant. There was significantly higher mean 12 hr chest tube loss (655 ±580 ml vs. 503±_378 ml; Kruskal-Wallis p=0.050) and platelet transfusion (17.96% vs. 9.82%; Pearson's chi-squares p=.033) with PRAS. However, there were no clinically important differences in packed red cell transfusion units (mean 2.08±3.00 PRAS vs. 1.71±2.23 CLOP; Kruskal-Wallis p=0.442) or total donor exposure units (4.43±7.58 PRAS vs. 3.00±4.54 CLOP; Kruskal-Wallis p=0.463). Despite this increase in observed bleeding, PRAS was associated with a lower rate of death in patients undergoing CABG.
- © 2010 by American Heart Association, Inc.