Letter by Gasparovic et al Regarding Article, “Aspirin Plus Clopidogrel Versus Aspirin Alone After Coronary Artery Bypass Grafting: The Clopidogrel After Surgery for Coronary Artery Disease (CASCADE) Trial”

Abstract

We thank Gasparovic et al and Bisdas et al for their interest and insightful comments regarding our recently published Clopidogrel after Surgery for Coronary Artery Disease (CASCADE) study.1 CASCADE was a randomized, placebo-controlled trial that evaluated the impact of adding clopidogrel to aspirin on the process of saphenous vein graft disease after coronary artery bypass graft surgery (CABG).2 Compared with aspirin alone, the combination of aspirin plus clopidogrel did not significantly reduce vein graft intimal hyperplasia 1 year after CABG, as assessed by intravascular ultrasound. Although CASCADE was not powered for angiographic or clinical outcomes, we also did not see a significant difference in vein graft patency or cardiovascular events between the 2 treatment groups.1 As noted by Bisdas et al, 1-year vein graft patency in CASCADE was >90%, in contrast to other recently published CABG studies.3 We attribute our favorable patency data to the early administration of antiplatelet therapy on the day of surgery,2 the frequent …