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Updated: Jun 21, 2025
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Preventive medication efficacy after 1-year follow-up for graft failure in coronary artery bypass surgery patients:
Mikko Uimonen1,2, Rasmus Liukkonen2, Ville Ponkilainen3
1Tampere University Hospital, Heart Hospital, Elämänaukio 1, 33520 Tampere, Finland.
Insights
Dual antiplatelet therapy, specifically ticagrelor or clopidogrel with aspirin, significantly reduces graft failure after coronary artery bypass graft surgery. These medications offer superior protection against graft failure compared to placebo at one year post-surgery.
Area of Science:
- Cardiovascular Surgery
- Pharmacology
- Evidence-Based Medicine
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure to treat coronary artery disease.
- Graft failure is a significant complication that can lead to adverse cardiovascular events and reduced long-term survival.
- Preventive medications are often used to improve graft patency, but their comparative efficacy requires rigorous evaluation.
Purpose of the Study:
- To systematically compare the effectiveness of various preventive medications in reducing graft failure in CABG patients.
- To identify the most efficacious medication strategies for maintaining graft patency at one year post-surgery.
Main Methods:
- A systematic review and Bayesian network meta-analysis of randomized controlled trials (RCTs) were conducted.
- Searches were performed in major databases (PubMed, Scopus, Web of Science) for relevant RCTs published up to February 2023.
- The primary outcome was graft failure at one year, with secondary outcomes including mortality, bleeding, and major adverse cardio- and cerebrovascular events (MACE).
Main Results:
- Eighteen RCTs involving 11,898 patients were included in the analysis.
- Acetylsalicylic acid (ASA), clopidogrel + ASA, dipyridamole + ASA, ticagrelor, and ticagrelor + ASA all demonstrated superiority over placebo in preventing graft failure.
- Dual antiplatelet therapy (DAPT) with ticagrelor + ASA (SUCRA 0.859) and clopidogrel + ASA (SUCRA 0.819) showed the highest probability of being the most efficacious.
- A trend towards increased bleeding risk and decreased MACE risk was observed with medication use compared to placebo.
Conclusions:
- Dual antiplatelet therapy combining aspirin with either ticagrelor or clopidogrel is the most effective strategy for preventing graft failure in CABG patients at one year.
- These findings support the use of DAPT to improve long-term graft patency and potentially reduce adverse cardiovascular events after CABG surgery.
Abstract:
To compare preventive medications against graft failures in coronary artery bypass graft surgery (CABG) patients after a 1-year follow-up. Systematic review with Bayesian network meta-analysis and meta-regression analysis. We searched PubMed, Scopus, and Web of Science databases in February 2023 for randomized controlled trials, comparing preventive medications against graft failure in CABG patients. We included studies that reported outcomes at 1 year after surgery. Our primary outcome was graft failure After screening 11,898 studies, a total of 18 randomized trials were included. Acetylsalicylic acid (ASA) [odds ratios (OR) 0.51, 95% credibility interval (CrI) 0.28-0.95, meta-regression OR 0.54, 95% CrI 0.26-1.00], Clopidogrel + ASA (OR 0.27, 95% CrI 0.09-0.76, meta-regression OR 0.28, 95% CrI 0.09-0.85), dipyridamole + ASA (OR 0.50, 95% CrI 0.30-0.83, meta-regression OR 0.49, 95% CrI 0.26-0.90), ticagrelor (OR 0.40, 95% CrI 0.16-1.00, meta-regression OR 0.43, 95% CrI 0.15-1.2), and ticagrelor + ASA (OR 0.26, 95% CrI 0.10-0.62, meta-regression OR 0.28, 95% CrI 0.10-0.68) were superior to placebo in preventing graft failure. Rank probabilities suggested the highest likelihood to be the most efficacious for ticagrelor + ASA [surface under the cumulative ranking (SUCRA) 0.859] and clopidogrel + ASA (SUCRA 0.819). The 95% CrIs of ORs for mortality, bleeding, and major adverse cardio- and cerebrovascular events (MACE) were wide. A trend towards increased bleeding risk and decreased MACE risk was observed when any of the medication regimens were used when compared to placebo. Sensitivity analysis excluding studies with a high risk of bias yielded equivalent results. Of the reviewed medication regimens, dual antiplatelet therapy combining ASA with ticagrelor or clopidogrel was found to result in the lowest rate of graft failures.
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