Dual Antiplatelet Therapy vs. Aspirin Monotherapy After Elective CABG in Patients with Reduced Ejection Fraction
Presented During:
Monday, May 4, 2026: 9:00AM - 4:00PM
McCormick Place Lakeside Center
Posted Room Name:
Exhibit Hall, Poster Area
Abstract No:
P0128
Submission Type:
Abstract Submission
Authors:
Chris Hsu (1), Sudhanvan Iyer (1), Ali Shirafkan (1)
Institutions:
(1) University of Texas Medical Branch, Galveston, TX
Submitting Author:
Chris Hsu
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University of Texas Medical Branch
University of Texas Medical Branch
Co-Author(s):
Sudhanvan Iyer
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University of Texas Medical Branch
University of Texas Medical Branch
Ali Shirafkan
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University of Texas Medical Branch
University of Texas Medical Branch
Presenting Author:
Chris Hsu
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UTMB-Galveston
UTMB-Galveston
Abstract:
Objective:
The American College of Cardiology and American Heart Association guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel following CABG performed after acute coronary syndrome (ACS). However, the role of DAPT remains unclear in patients with heart failure with reduced ejection fraction (HFrEF) undergoing elective CABG. We investigated short- and mid-term outcomes of aspirin (ASA) monotherapy versus DAPT following elective CABG in patients with HFrEF.
Methods:
Using the TriNetX research network, we retrospectively analyzed electronic health records from 71 healthcare organizations in the United States. Adults with HFrEF undergoing elective CABG at least one month after ACS were assigned to ASA monotherapy (n= 5,629) or ASA + clopidogrel (n = 11,329). Propensity score matching yielded 5,495 patients per group. Outcomes included all-cause mortality, stroke, myocardial infarction (MI), atrial fibrillation (AF), revascularization, and bleeding at 90 days and 1-year post-CABG.
Results:
At 90 days, patients on DAPT experienced a lower risk of mortality compared to ASA alone (4.7% vs 6.7%, risk ratio [RR] 0.701, 95% CI 0.600-0.819, p <0.001). Risk of MI and revascularization was higher in the DAPT group while the ASA group had non-significant, lower rates of bleeding, AF, and stroke. At 1 year, mortality remained lower in the DAPT group (7.7% vs 9.8%, RR 0.787, 95% CI 0.713 – 0.855, p < 0.001). Similar non-significant trends in bleeding, AF, and stroke were observed at 1 year vs 90 days.
Conclusion:
DAPT using clopidogrel and ASA after elective CABG in patients with HFrEF is associated with a reduction in 90-day and 1-year mortality when compared to ASA monotherapy, despite an increase in bleeding risk. However, other major ischemic events, such as stroke, MI, and revascularization, were higher in DAPT than ASA alone. These findings support that DAPT may reduce all-cause mortality despite a higher risk of ischemic events, suggesting a reduction of severity in thrombotic events or stabilization of high-risk plaques. These findings may inform new post-CABG antiplatelet strategies in patients with HFrEF, but further studies are needed to clarify this net clinical benefit and guide evidence-based recommendations.
The American College of Cardiology and American Heart Association guidelines recommend dual antiplatelet therapy (DAPT) with aspirin and clopidogrel following CABG performed after acute coronary syndrome (ACS). However, the role of DAPT remains unclear in patients with heart failure with reduced ejection fraction (HFrEF) undergoing elective CABG. We investigated short- and mid-term outcomes of aspirin (ASA) monotherapy versus DAPT following elective CABG in patients with HFrEF.
Methods:
Using the TriNetX research network, we retrospectively analyzed electronic health records from 71 healthcare organizations in the United States. Adults with HFrEF undergoing elective CABG at least one month after ACS were assigned to ASA monotherapy (n= 5,629) or ASA + clopidogrel (n = 11,329). Propensity score matching yielded 5,495 patients per group. Outcomes included all-cause mortality, stroke, myocardial infarction (MI), atrial fibrillation (AF), revascularization, and bleeding at 90 days and 1-year post-CABG.
Results:
At 90 days, patients on DAPT experienced a lower risk of mortality compared to ASA alone (4.7% vs 6.7%, risk ratio [RR] 0.701, 95% CI 0.600-0.819, p <0.001). Risk of MI and revascularization was higher in the DAPT group while the ASA group had non-significant, lower rates of bleeding, AF, and stroke. At 1 year, mortality remained lower in the DAPT group (7.7% vs 9.8%, RR 0.787, 95% CI 0.713 – 0.855, p < 0.001). Similar non-significant trends in bleeding, AF, and stroke were observed at 1 year vs 90 days.
Conclusion:
DAPT using clopidogrel and ASA after elective CABG in patients with HFrEF is associated with a reduction in 90-day and 1-year mortality when compared to ASA monotherapy, despite an increase in bleeding risk. However, other major ischemic events, such as stroke, MI, and revascularization, were higher in DAPT than ASA alone. These findings support that DAPT may reduce all-cause mortality despite a higher risk of ischemic events, suggesting a reduction of severity in thrombotic events or stabilization of high-risk plaques. These findings may inform new post-CABG antiplatelet strategies in patients with HFrEF, but further studies are needed to clarify this net clinical benefit and guide evidence-based recommendations.
ADULT CARDIAC:
Coronary Artery Disease
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