Zhu Yunpeng, Xue Qing, Zhang Minlu, Hu Junlong, Liu Hao, Wang Rui, Wang Xiaowei, Han Lin, Zhao Qiang
Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Cardiovascular Surgery, Changhai Hospital of Shanghai, Shanghai, China.
J Thorac Dis. 2020 Sep;12(9):4915-4923. doi: 10.21037/jtd-20-1177.
In the present post hoc analysis of the DACAB trial, we evaluated the effects of ticagrelor with or without aspirin on 1-year vein graft outcomes after coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB) (on-pump and off-pump).
The DACAB trial was a multicenter, randomized, open-label, parallel control study enrolling 500 patients with 1,460 vein grafts undergoing CABG. For current post-hoc study, all patients in the DACAB study were included in the analysis to compare the effects of different antiplatelet regimens under on/off pump. Patients were randomly assigned to 1 of 3 antiplatelet treatment regimens (ticagrelor plus aspirin, T + A; ticagrelor alone, T; or aspirin alone, A) within 24 hours after CABG, and were stratified into on-pump and off-pump subgroups. The primary outcome was 1-year vein graft patency rate.
Totally 121 patients underwent on-pump CABG (39 with 121 vein grafts in T + A, 36 with 101 vein grafts in T, and 46 with 137 vein grafts in A) and 379 patients underwent off-pump CABG (129 with 336 vein grafts in T + A, 130 with 387 vein grafts in T, and 120 with 348 vein grafts in A). Compared with A, T + A showed a higher 1-year vein graft patency rate in both on-pump (adjusted OR for non-patency =0.62, 95% CI: 0.16-2.45) and off-pump (adjusted OR for non-patency =0.35, 95% CI: 0.20-0.62) subgroups, P interaction =0.647; whereas T did not in either on-pump (adjusted OR for non-patency = 0.92, 95% CI: 0.31-2.76) or off-pump (adjusted OR for non-patency =0.58, 95% CI: 0.34-1.00) subgroups, P interaction =0.430.
In the DACAB trial, for patients underwent either on-pump or off-pump CABG, ticagrelor plus aspirin showed consistent benefit for achieving 1-year vein graft patency, with particular benefit being seen in the off-pump.
在对DACAB试验进行的本次事后分析中，我们评估了替格瑞洛联合或不联合阿司匹林对冠状动脉旁路移植术（CABG）有或无体外循环（CPB）（体外循环和非体外循环）后1年静脉桥血管结局的影响。
DACAB试验是一项多中心、随机、开放标签、平行对照研究，纳入了500例接受CABG且有1460条静脉桥血管的患者。对于本次事后研究，DACAB研究中的所有患者均纳入分析，以比较体外循环/非体外循环下不同抗血小板治疗方案的效果。患者在CABG术后24小时内被随机分配至3种抗血小板治疗方案之一（替格瑞洛加阿司匹林，T+A；单用替格瑞洛，T；或单用阿司匹林，A），并被分为体外循环和非体外循环亚组。主要结局为1年静脉桥血管通畅率。
共有121例患者接受体外循环CABG（T+A组39例，121条静脉桥血管；T组36例，101条静脉桥血管；A组46例，137条静脉桥血管），379例患者接受非体外循环CABG（T+A组129例，336条静脉桥血管；T组130例，387条静脉桥血管；A组120例，348条静脉桥血管）。与A组相比，T+A组在体外循环（未通畅调整OR=0.62，95%CI：0.16-2.45）和非体外循环（未通畅调整OR=0.35，95%CI：0.20-0.62）亚组中均显示出较高的1年静脉桥血管通畅率，P交互作用=0.647；而T组在体外循环（未通畅调整OR=0.92，95%CI：0.31-2.76）或非体外循环（未通畅调整OR=0.58，95%CI：0.34-1.00）亚组中均未显示出差异，P交互作用=0.430。
在DACAB试验中，对于接受体外循环或非体外循环CABG的患者，替格瑞洛联合阿司匹林在实现1年静脉桥血管通畅方面显示出一致的益处，在非体外循环中益处尤为明显。
