Clopidogrel versus Ticagrelor for Secondary Prevention after Coronary Artery Bypass Grafting

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Pharmacology

Background:

• Off-pump coronary artery bypass grafting (OPCAB) with arterial grafts is a strategy for non-ST-elevation acute coronary syndrome (NSTE-ACS).
• Dual antiplatelet therapy (DAPT) duration after OPCAB, particularly with arterial grafts, requires evaluation for optimal patient outcomes.
• Understanding the comparative efficacy and safety of different DAPT regimens is crucial for managing NSTE-ACS patients post-OPCAB.

Purpose of the Study:

• To evaluate the outcomes of three-month DAPT in NSTE-ACS patients following total arterial OPCAB.
• To compare the safety and efficacy of aspirin plus clopidogrel (ASA + CPD) versus aspirin plus ticagrelor (ASA + TCG) in this patient cohort.
• To assess overall survival and the composite outcome of major adverse cerebrovascular and cardiovascular events (MACCE) and major bleeding.

Main Methods:

• A retrospective study of 269 NSTE-ACS patients undergoing total arterial OPCAB between 2013-2016.
• Patients received either ASA + CPD or ASA + TCG for three months postoperatively.
• One-to-one propensity score matching was used for comparative analysis of outcomes, including overall survival and MACCE/major bleeding composite endpoint.

Main Results:

• Three-month DAPT was completed by 96% of patients.
• Unadjusted and propensity score-matched analyses showed no significant differences in overall survival or the composite outcome of MACCE and major bleeding between the ASA + CPD and ASA + TCG groups.
• One-year freedom from the composite outcome was high in both groups (91 ± 3% for ASA + CPD vs. 93 ± 2% for ASA + TCG).

Conclusions:

• Three-month DAPT, utilizing either aspirin plus clopidogrel or aspirin plus ticagrelor, demonstrates acceptable outcomes in NSTE-ACS patients after total arterial OPCAB.
• The choice between ASA + CPD and ASA + TCG did not significantly impact overall survival or the combined endpoint of MACCE and major bleeding in this study.
• These findings support the use of a three-month DAPT strategy in patients with NSTE-ACS undergoing total arterial OPCAB, with comparable safety and efficacy between the two regimens.