Department of Pharmacy, Zhongshan Hospital, Fudan University.
Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Int J Surg. 2024 Jun 1;110(6):3450-3460. doi: 10.1097/JS9.0000000000001246.
Ticagrelor is reportedly more effective than clopidogrel in preventing atherothrombotic events in patients with percutaneous coronary intervention. However, the optimal antiplatelet therapy strategy after off-pump coronary artery bypass grafting (OPCABG) is yet to be established.
This study was performed using the prospectively-maintained database at our institution. Patients who underwent OPCABG were divided into the clopidogrel and the ticagrelor groups. Propensity score matching analysis was performed between the two groups. The clinical outcome was the occurrence of major adverse cardiovascular event (MACE), defined as a composite of vascular death, myocardial infarction, or stroke 1-year after surgery.
In total, 545 patients completed the entire follow-up assessment. After propensity score matching, 232 patients each were included in the clopidogrel and ticagrelor groups. The primary outcome occurred in 7.8 and 4.3% of patients in the clopidogrel and ticagrelor groups, respectively ( P =0.113). CYP2C19 variants (*2, *3, and *17) did not impact the clinical outcomes, regardless of the use of clopidogrel or ticagrelor. The rates of MACE were significantly lower in patients carrying the ABCB1 C3435T CT/TT genotypes in the ticagrelor group than in those carrying the ABCB1 C3435T CC genotype in the clopidogrel group (1.4 vs. 9.1%, adjusted P =0.030), as well as those carrying the ABCB1 C3435T CC genotype in the ticagrelor group (1.4 vs. 8.9%, adjusted P =0.036). The ABCB1 C3435T CC genotype was significantly associated with the incidence of 1-year MACE (HR=1.558, 95% CI: 1.109-2.188, P =0.011). Patients who experienced severe perioperative bleeding exhibited a significantly higher incidence of MACE than those who did not experience severe perioperative bleeding (14.0 vs. 4.9%, adjusted P =0.007).
There was no significant difference in the 1-year MACE between patients receiving clopidogrel and those receiving ticagrelor after OPCABG. Notably, The ABCB1 C3435T CC genotype was related to a higher risk of MACE.
替格瑞洛据报道在预防经皮冠状动脉介入治疗患者的动脉血栓栓塞事件方面比氯吡格雷更有效。然而，在非体外循环冠状动脉旁路移植术（OPCABG）后最佳的抗血小板治疗策略尚未确定。
本研究使用我们机构前瞻性维护的数据库进行。接受 OPCABG 的患者分为氯吡格雷组和替格瑞洛组。对两组患者进行倾向评分匹配分析。临床结果是主要不良心血管事件（MACE）的发生，定义为手术后 1 年内血管死亡、心肌梗死或中风的复合事件。
总共有 545 例患者完成了整个随访评估。经过倾向评分匹配后，氯吡格雷组和替格瑞洛组各有 232 例患者。氯吡格雷组和替格瑞洛组的主要结局发生率分别为 7.8%和 4.3%（P=0.113）。CYP2C19 变体（*2、3 和17）无论使用氯吡格雷还是替格瑞洛，都不会影响临床结局。在替格瑞洛组中，携带 ABCB1 C3435T CT/TT 基因型的患者的 MACE 发生率明显低于氯吡格雷组中携带 ABCB1 C3435T CC 基因型的患者（1.4%比 9.1%，调整后 P=0.030），也低于替格瑞洛组中携带 ABCB1 C3435T CC 基因型的患者（1.4%比 8.9%，调整后 P=0.036）。ABCB1 C3435T CC 基因型与 1 年 MACE 的发生率显著相关（HR=1.558，95%CI：1.109-2.188，P=0.011）。发生严重围手术期出血的患者 MACE 发生率明显高于未发生严重围手术期出血的患者（14.0%比 4.9%，调整后 P=0.007）。
在 OPCABG 后接受氯吡格雷和替格瑞洛的患者 1 年内 MACE 发生率无显著差异。值得注意的是，ABCB1 C3435T CC 基因型与 MACE 风险增加相关。
Zotero 插件
