Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome.
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Jeppsson Anders, James Stefan, Moller Christian H, Malm Carl Johan, Dalén Magnus, Vanky Farkas, Modrau Ivy Susanne, Andersen Karl, Anttila Vesa, Atroshchenko Gennady V, Barbu Mikael, Dreifaldt Mats, El-Akkawi Ali Imad, Friberg Örjan, Gudbjartsson Tomas, Gunn Jarmo, Haaverstad Rune, Halonen Jari, Hansson Emma C, Holm Jonas, Husso Annastiina, Juvonen Tatu, Jakobsen Øyvind, Jideus Lena, Johannesson Emilia, Jonsson Holmdahl Anna, Jonsson Kristjan, Kolseth Solveig Moss, Krasniqi Lytfi, Mäkelä Tuomas, Mennander Ari, Mohagen Krogstad Lars-Erik, Rafiq Sulman, Raivio Peter, Riber Lars, Tahir Aminah, Thorsen Carl, Tønnessen Theis, Wahba Alexander, Zindovic Igor, Pivodic Aldina, Nielsen Susanne J, Erlinge David, Alfredsson Joakim, Sartipy Ulrik, TACSI Trial Group., TACSI Trial Group
Аннотация
METHODS: In this open-label, registry-based, clinical trial conducted at 22 Nordic cardiothoracic surgery centers, we randomly assigned patients in a 1:1 ratio to receive either ticagrelor plus aspirin or aspirin alone for 1 year after CABG for an acute coronary syndrome. The primary outcome was a composite of death, myocardial infarction, stroke, or repeat revascularization, evaluated at 1 year. A key secondary outcome was net adverse clinical events, defined as a primary-outcome event or major bleeding.
RESULTS: A total of 2201 patients were randomly assigned to receive ticagrelor plus aspirin (1104 patients) or aspirin alone (1097 patients). The mean age of the patients was 66 years, and 14.4% were women. A primary-outcome event occurred in 53 patients (4.8%) in the ticagrelor-plus-aspirin group and 50 (4.6%) in the aspirin-alone group (hazard ratio, 1.06; 95% confidence interval [CI], 0.72 to 1.56; P = 0.77). Net adverse clinical events occurred in 9.1% of patients in the ticagrelor-plus-aspirin group and 6.4% in the aspirin-alone group (hazard ratio, 1.45; 95% CI, 1.07 to 1.97). Major bleeding occurred in 4.9% of patients in the ticagrelor-plus-aspirin group and 2.0% in the aspirin-alone group (hazard ratio, 2.50; 95% CI, 1.52 to 4.11).
CONCLUSIONS: Among patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year. (Funded by the Swedish Research Council and others; TACSI ClinicalTrials.gov number, NCT03560310; EudraCT number, 2017-001499-43; EU Clinical Trials number, 2023-508551-40-00.).