Predictors of Secondary Revascularization after Coronary Artery Bypass Graft Surgery and Role of Dual Antiplatelet Therapy

Background: Despite advancements in surgical techniques, interventional procedures, novel pharmacotherapies, and other contemporary treatments, patients’ post-CABG remain at risk for graft failure and progression of native CAD (4). Consequently, secondary revascularization is often required, with PCI being the preferred method Methods: Th is is a retrospective observational study evaluating the incidence, trends, and predictors of revascularization after CABG surgery. Antiplatelet therapy and its impact on revascularization after CABG were analyzed. Results: Of 2,476 patients followed in this post-CABG study, the analysis included 1,006 patients who received AMT and 770 patients who received DAPT for six months or more after surgery. The survival rates were 92.0% for AMT and 96.5% for the DAPT group (odds ratio (OR)=0.421, 95% confidence interval (95% CI): 0.269-0.658; p<0.001). In patients who received DAPT after CABG, a significantly higher incidence of revascularization was noted, compared to AMT (22.08% vs 6.96%; OR=3.157, 95% CI: 2.734-4.940; p<0.001). The binary regression model revealed that younger patients (HR=0.964, 95% CI: 0.95-0.97; p <0.001), diabetics (HR=1.50, 95% CI: 1.12-2.00, p=0.007), patients who had fewer internal mammary artery grafts (HR=0.54, 95% CI: 0.36-0.81, p=0.003), and patients receiving DAPT of any duration after CABG (HR=3.47, 95% CI: 2.55-4.72, p<0.001) were more likely to receive revascularization after CABG (Table 2). The model, comprising these four predictors, was able to explain 12.8% of the variance in post-CABG revascularization (Nagelkerke R² = 0.128; p < 0.001). Conclusion: Diabetes mellitus, younger age, fewer IMA grafts, and the use of DAPT after CABG were strong predictors of the need for secondary revascularization