替格瑞洛或阿司匹林用于慢性肾脏病患者冠状动脉旁路移植术后。

Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With Chronic Kidney Disease.

机构信息

Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.

German Heart Center Munich, Technical University of Munich, Munich, Germany; German Center for Cardiovascular Research, Munich Heart Alliance, Munich, Germany.

出版信息

Ann Thorac Surg. 2022 Feb;113(2):554-562. doi: 10.1016/j.athoracsur.2021.03.061. Epub 2021 Apr 2.

DOI:10.1016/j.athoracsur.2021.03.061

PMID:33819474

Abstract

BACKGROUND

The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery remains unknown.

METHODS

This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor vs aspirin in patients with and patients without CKD. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), namely, the composite of cardiovascular death, stroke, myocardial infarction, or revascularization at 1 year after coronary artery bypass graft surgery. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding.

RESULTS

Chronic kidney disease was present in 276 of 1843 randomized patients (15%). Patients with CKD vs patients without CKD had higher 1-year rates of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval [CI], 1.12 to 2.39; P = .01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95% CI, 1.03 to 3.28; P = .04). The 1-year rate of MACCE was increased with ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95% CI, 1.08 to 4.30; P = .03), but not in patients without CKD (8.5% vs 8.1%, HR 1.05; 95% CI, 0.74 to 1.49; P = .79; P = .067). There was no difference in the 1-year rate of major bleeding with ticagrelor vs aspirin in patients with CKD (6.6% vs 4.7%, HR 1.44; 95% CI, 0.52 to 3.97; P = .48) and patients without CKD (3.3% vs 2.9%, HR 1.14; 95% CI, 0.64 to 2.01; P = .65).

CONCLUSIONS

Among patients with CKD and coronary artery bypass graft surgery, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared with those who received aspirin.

摘要

背景

慢性肾脏病（CKD）患者行冠状动脉旁路移植术（CABG）的最佳抗血小板治疗仍不清楚。

方法

这项 Ticagrelor 在冠状动脉旁路移植术中（TiCAB）试验的事后分析检查了替格瑞洛与阿司匹林在 CKD 患者和非 CKD 患者中的疗效和安全性。主要终点是主要不良心脏和脑血管事件（MACCE），即 1 年后心血管死亡、中风、心肌梗死或血运重建的复合终点。次要终点包括主要终点的各个组成部分、全因死亡和大出血。

结果

在 1843 名随机患者中，276 名患者患有 CKD（15%）。与无 CKD 患者相比，有 CKD 患者的 1 年 MACCE 发生率更高（13%对 8.3%，风险比[HR]1.63；95%置信区间[CI]1.12 至 2.39；P=0.01）和大出血发生率更高（5.6%对 3.1%，HR 1.84；95%CI1.03 至 3.28；P=0.04）。与阿司匹林相比，替格瑞洛在 CKD 患者中的 1 年 MACCE 发生率更高（18.2%对 8.9%，HR 2.15；95%CI1.08 至 4.30；P=0.03），但在无 CKD 患者中则无差异（8.5%对 8.1%，HR 1.05；95%CI0.74 至 1.49；P=0.79；P=0.067）。在 CKD 患者中，替格瑞洛与阿司匹林的 1 年大出血发生率无差异（6.6%对 4.7%，HR 1.44；95%CI0.52 至 3.97；P=0.48）和无 CKD 患者（3.3%对 2.9%，HR 1.14；95%CI0.64 至 2.01；P=0.65）。