Dual Antiplatelet Therapy (DAPT) in Patients with NSTEMI Undergoing CABG

BackgroundDual antiplatelet therapy (DAPT), combining acetylsalicylic acid (aspirin) and a P2Y12 inhibitor, is recommended for patients with non-ST segment elevation myocardial infarction (NSTEMI) undergoing coronary artery bypass grafting (CABG). However, real-world adoption and effectiveness of DAPT in this context has not been adequately evaluated. MethodsWe conducted a retrospective propensity-matched cohort analysis using data from the TriNetX research network, which includes electronic health records from over 70 healthcare organizations across the United States. The study included patients aged >18 years diagnosed with NSTEMI who underwent CABG within one month of presentation from January 2015 to January 2024. Outcomes for patients on DAPT were compared with those on aspirin monotherapy using standardized mean differences, risk ratios, and Cox proportional hazard models for survival analysis. ResultsFrom a cohort of 21,092 NSTEMI patients eligible for DAPT post-CABG, 55.28% received DAPT predominantly consisting of aspirin and clopidogrel. After propensity score matching, DAPT was associated with significantly reduced all-cause mortality at 1-year (8.1% vs 5.5%, OR: 1.52) and 5-year (14.4% vs 10.6%, OR: 1.41) follow-ups compared to aspirin monotherapy. There were no significant differences in rates of major bleeding, ischemic strokes, or repeat revascularization between the two groups. ConclusionThe underutilization of DAPT in real-world settings, despite guideline recommendations, reflects a potential gap between clinical practice and evidence-based guidelines. Our findings support the effectiveness of DAPT in reducing mortality without increasing major bleeding risks, underscoring the need for more widespread adoption and potentially more robust clinical trials to confirm these observational findings.