Jacqueline Saw1, Graham C Wong1, John Mayo2, Victoria Bernstein1, G B John Mancini1, Jian Ye3, Peter Skarsgard3, Andrew Starovoytov1, John Cairns1. 1. Divisions of Cardiology, Vancouver General Hospital & St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 2. Divisions of Radiology, Vancouver General Hospital & St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada. 3. Divisions of Cardiovascular Surgery, Vancouver General Hospital & St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND:Ticagrelor was shown to reduce mortality in patients who underwent coronary artery bypass grafting (CABG), but its effect on graft patency is unknown. METHODS: We performed a prospective, randomised, double-blind, placebo-controlled trial, comparing ticagrelor 90 mg twice daily versus placebo for 3 months added to aspirin 81 mg/day, following isolated CABG. Aspirin was started within 12 h, and study medication within 72 h after CABG. Primary outcome was graft occlusion on CT angiography (CTA) performed 3 months post CABG. Patients were followed to 12 months for death, myocardial infarction, stroke, repeat revascularisation and bleeding. RESULTS: The study was terminated prematurely after randomising 70 patients between September 2011 and August 2014 because of slow recruitment. CTA was performed in 56 patients who completed >1 month of study drug. Graft occlusion occurred in 7/25 (28.0%) patients on ticagrelor and 17/31 (48.3%) on placebo, p=0.044. Of 207 analysable grafts, graft occlusion occurred in 9/87 (10.3%) with ticagrelor and 22/120 (18.3%) with placebo, p=0.112. Graft occlusion or stenosis ≥50% occurred in 10/87 (11.5%) ticagrelor vs 32/120 (26.7%) placebo, p=0.007. There was no major bleeding, but minor bleeding was higher with ticagrelor (31.4% vs 2.9%, p=0.003). In univariate analysis, ticagrelor use reduced graft occlusion (OR 0.32, 95% CI 0.10 to 0.97, p=0.047), which remained significant on multivariable analysis (OR 0.25, 95% CI 0.073 to 0.873, p=0.03). CONCLUSIONS:Ticagrelor added to aspirin after CABG reduced the proportion of patients with graft occlusion, and was a significant univariate and multivariable predictor of graft occlusion. These results are hypothesis-generating and should be confirmed in larger studies. TRIAL REGISTRATION NUMBER: NCT01373411: Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
RCT Entities:
BACKGROUND:Ticagrelor was shown to reduce mortality in patients who underwent coronary artery bypass grafting (CABG), but its effect on graft patency is unknown. METHODS: We performed a prospective, randomised, double-blind, placebo-controlled trial, comparing ticagrelor 90 mg twice daily versus placebo for 3 months added to aspirin 81 mg/day, following isolated CABG. Aspirin was started within 12 h, and study medication within 72 h after CABG. Primary outcome was graft occlusion on CT angiography (CTA) performed 3 months post CABG. Patients were followed to 12 months for death, myocardial infarction, stroke, repeat revascularisation and bleeding. RESULTS: The study was terminated prematurely after randomising 70 patients between September 2011 and August 2014 because of slow recruitment. CTA was performed in 56 patients who completed >1 month of study drug. Graft occlusion occurred in 7/25 (28.0%) patients on ticagrelor and 17/31 (48.3%) on placebo, p=0.044. Of 207 analysable grafts, graft occlusion occurred in 9/87 (10.3%) with ticagrelor and 22/120 (18.3%) with placebo, p=0.112. Graft occlusion or stenosis ≥50% occurred in 10/87 (11.5%) ticagrelor vs 32/120 (26.7%) placebo, p=0.007. There was no major bleeding, but minor bleeding was higher with ticagrelor (31.4% vs 2.9%, p=0.003). In univariate analysis, ticagrelor use reduced graft occlusion (OR 0.32, 95% CI 0.10 to 0.97, p=0.047), which remained significant on multivariable analysis (OR 0.25, 95% CI 0.073 to 0.873, p=0.03). CONCLUSIONS:Ticagrelor added to aspirin after CABG reduced the proportion of patients with graft occlusion, and was a significant univariate and multivariable predictor of graft occlusion. These results are hypothesis-generating and should be confirmed in larger studies. TRIAL REGISTRATION NUMBER: NCT01373411: Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
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Authors: Sigrid Sandner; Björn Redfors; Dominick J Angiolillo; Katia Audisio; Stephen E Fremes; Paul W A Janssen; Alexander Kulik; Roxana Mehran; Joyce Peper; Marc Ruel; Jacqueline Saw; Giovanni Jr Soletti; Andrew Starovoytov; Jurrien M Ten Berg; Laura M Willemsen; Qiang Zhao; Yunpeng Zhu; Mario Gaudino Journal: JAMA Date: 2022-08-09 Impact factor: 157.335
Authors: Karla Solo; Shahar Lavi; Conrad Kabali; Glenn N Levine; Alexander Kulik; Ava A John-Baptiste; Stephen E Fremes; Janet Martin; John W Eikelboom; Marc Ruel; Ashlay A Huitema; Tawfiq Choudhury; Deepak L Bhatt; Nikolaos Tzemos; Mamas A Mamas; Rodrigo Bagur Journal: BMJ Date: 2019-10-10