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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 . . . [Full Text of this Article]

Steven G. Coca, DO; Chirag R. Parikh, MD, PhD
chirag.parikh@yale.edu
Department of Internal Medicine
Yale University School of Medicine
New Haven, Conn

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