This article is more than 5 years old. Information may no longer be current.
DACAB: Ticagrelor plus aspirin improves saphenous vein graft patency at 1 year post-CABG
Click Here to Manage Email Alerts
ANAHEIM, Calif. — Patients undergoing CABG who received dual antiplatelet therapy consisting of ticagrelor plus aspirin had improved saphenous vein graft patency at 1 year compared with aspirin monotherapy, without excess risk for major bleeding, according to the DACAB trial results.
“Currently, the saphenous vein graft is the most commonly used in CABG surgery, but the failure rate is high at 1 year, and the occlusion rate is as high as 50% at 10 years,” Qiang Zhao, MD, from the Ruijin Hospital Shanghai Jiao Tong University School of Medicine, China, said during a press conference at the American Heart Association Scientific Sessions. “Dual antiplatelet therapy may reduce vein graft failure, but there are limited data to support this idea and there is a gap in the European and American guidelines.”
The open-label trial enrolled 500 adults undergoing CABG at six hospitals in China. Patients were randomly assigned to receive ticagrelor (Brilinta, AstraZeneca) 90 mg plus aspirin (n = 168), ticagrelor 90 mg alone (n = 166) or aspirin alone (n = 166).
The primary efficacy outcome was saphenous vein graft patency as measured by CT scan or coronary angiography at 1 year. Secondary outcomes included saphenous vein graft patency at 7 days, MACE — defined as CV death, MI or stroke — within 1 year, recurrence of angina within 1 year, atrial fibrillation within 7 days and TIMI major bleeding within 1 year.
At 1 year, 93.4% of patients with 93.8% were assessed for the primary outcome.
In the intention-to-treat analysis, results at 1 year highlighted a 12.2% difference in rates of patency between the ticagrelor-plus-aspirin group and the aspirin-alone group (88.7% vs. 76.5%; P = .006), Zhao said during the press conference. Additionally, the researchers found a 6.3% difference in the rate of patency favoring ticagrelor alone over aspirin alone (82.8% vs. 76.5%; P = .0962).
Ticagrelor plus aspirin, as compared with aspirin alone, was associated with a better rate of non-occlusion at 1 year (89.8% vs. 80.6%; P = .006). The rate of non-occlusion was also improved with ticagrelor alone vs. aspirin alone, but the difference was not significant, according to Zhao.
Also at 1 year, the rates of MACE were low for all three groups, but lowest in the ticagrelor-plus-aspirin group, as compared with the ticagrelor-alone and aspirin-alone groups (1.8% vs. 2.4% vs. 5.4%).
Bleeding rates were low overall, with only one CABG-related event each in the ticagrelor-plus-aspirin and ticagrelor-alone groups and no events in the aspirin-alone group. The non-CABG-related bleeding rate was higher in the combination-therapy group, as compared with the ticagrelor-alone and aspirin-alone groups (30.4% vs. 12.1% vs. 9%); however, only two events were considered major bleeding. Overall rates of major bleeding, including CABG- and non-CABG-related events were low, with three events occurring in the combination-therapy group, two in the ticagrelor-alone group and none in the aspirin-alone group.
At baseline, the mean age was about 64 years. The rates of hypertension and hyperlipidemia were high, and more than 40% had diabetes. Most patients also had moderate-to-high SYNTAX scores and low-to-moderate EuroSCORE.
“Ticagrelor plus aspirin combination therapy significantly improves saphenous vein graft patency at 1 year after CABG when compared with aspirin monotherapy with a minimal risk for major bleeding,” Zhao said. – by Melissa Foster
Reference:
Zhao Q. LBS.01 – CABG and EP Peri-procedural Dilemmas. Presented at: American Heart Association Scientific Sessions; Nov. 11-15, 2017; Anaheim, California.
Disclosure: Zhao reports he has served as a speaker for AstraZeneca, Johnson & Johnson and Medtronic, and has been an investigator on clinical trials sponsored by AstraZeneca, Bayer, Novartis and Sanofi.