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June 13, 2007

Long-term Mortality Associated With Aprotinin Following Coronary Artery Bypass Graft Surgery

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;297(22):2475-2477. doi:10.1001/jama.297.22.2475-b

To the Editor: The cohort study by Dr Mangano and colleagues1 demonstrated that single administration of aprotinin during CABG surgery is associated not only with increased risk for end-organ damage in the short term2 but also with an increased risk of death in the long term. The discussion focused on the probable mechanistic role of aprotinin as the mediator of long-term death via coronary thrombosis. It cited several clinical studies supporting the notion that early arterial reocclusion results in late clinical sequelae, and that early coronary artery patency is responsible for the long-term benefits in outcomes for patients with acute myocardial infarction treated with fibrinolytics. However, the cited studies found an early separation of the survival curves; the differences in the event rates (re-intervention or death) between groups exposed to various interventions for acute myocardial infarction or coronary artery diseases are manifest within 6 to 12 months. Subsequent to follow-up of 6 to 12 months, the survival curves in these studies become parallel, as the differences in the hazard rates become similar over time. In contrast, the mortality curves displayed in Figure 2 of Mangano et al appear to show a steady time-dependent separation of the curves between the aprotinin-treated group and the lysine analog or control groups.

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