Clopidogrel versus Ticagrelor for Secondary Prevention after Coronary Artery Bypass Grafting

Journal of Clinical Medicine

KwangRee Cho¹  DongJin Kim¹  HeeJung Kim¹  JaeSuk Yoo¹  HyoungWoo Chang² 

[1] Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do 14754, Korea;Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do 13620, Korea;

关键词: acute coronary syndrome (ACS);    secondary prevention;    coronary artery bypass grafting;    clopidogrel;    antiplatelet therapy;   

DOI  :  10.3390/jcm8010104

来源: DOAJ

【 摘 要 】

We sought to evaluate the outcomes of postoperative three-month dual antiplatelet therapy in patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) following off-pump coronary artery bypass grafting (OPCAB) with exclusively arterial grafts. Between 2013–2016, dual antiplatelet therapy (DAPT) with either aspirin + clopidogrel (ASA + CPD group, n = 100) or aspirin + ticagrelor (ASA + TCG group, n = 169) was prescribed postoperatively in 269 NSTE-ACS patients after total arterial OPCAB. Patients with indications for other oral anticoagulants were excluded from the study. Three-month DAPT was completed in 259 patients (96%); ASA + CPD group (n = 94) vs. ASA + TCG group (n = 165). A one-to-one propensity score matching was performed. Unadjusted comparison between the groups showed no significant difference in overall survival (P = 0.253) and composite outcome of major adverse cerebrovascular and cardiovascular event (MACCE) and major bleeding (P = 0.276). The rate of freedom from composite outcome at one year in the ASA + CPD and ASA + TCG groups was 91 ± 3% and 93 ± 2%, respectively. In multivariable analysis, being in the ASA + TCG group did not increase the risk of the composite outcome of MACCE and major bleeding (P = 0.972, hazard ratio: 1.0, 95% confidence interval: 0.4–2.3). Propensity score-matched comparison (76 pairs) showed no significant difference in the overall survival (P = 0.423) and composite outcome between the groups (P = 0.442). In the setting of exclusive arterial grafting, post-OPCAB three-month DAPT showed acceptable outcomes in patients with NSTE-ACS. There was no significant difference in overall survival or composite outcome of MACCE and major bleeding between the ASA + CPD and ASA + TCG groups.

【 授权许可】

Unknown