TY - JOUR
T1 - Effect of Adding Ticagrelor to Standard Aspirin on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting (POPular CABG)
T2 - A Randomized, Double-Blind, Placebo-Controlled Trial
AU - Willemsen, Laura M.
AU - Janssen, Paul W. A.
AU - Peper, Joyce
AU - Soliman-Hamad, Mohamed A.
AU - van Straten, Albert H. M.
AU - Klein, Patrick
AU - Hackeng, Chris M.
AU - Sonker, Uday
AU - Bekker, Margreet W. A.
AU - von Birgelen, Clemens
AU - Brouwer, Marc A.
AU - van der Harst, Pim
AU - Vlot, Eline A.
AU - Deneer, Vera H. M.
AU - Yin, Dean R. P. P. Chan Pin
AU - Gimbel, Marieke E.
AU - Beukema, Kasper F.
AU - Daeter, Edgar J.
AU - Kelder, Johannes C.
AU - Tijssen, Jan G. P.
AU - Rensing, Benno J. W. M.
AU - van Es, Hendrik W.
AU - Swaans, Martin J.
AU - ten berg, Jurrien M.
N1 - Funding Information:
Dr Willemsen was coordinating investigator of this trial, conducted with funding from AstraZeneca. Dr Gimbel reports conducting research with funding from AstraZeneca. Dr Klein reports consultancy/speaker/proctoring with Edwards LifeSciences en BioVentrix Inc. Prof von Birgelen reports institutional research grants (Thoraxcentrum Twente) from Abbott Vascular, Biotronik, Boston Scientific, and Medtronic. Dr Swaans reports being proctor/lecturer for Abbott Vascular, Boston Scientific, and Philips Healthcare en Bioventrix Inc. Dr ten Berg reports institutional research grants from ZonMw (government institution) and AstraZeneca and being a lecturer for AstraZeneca, Eli Lilly, Daiichi Sankyo, The Medicines Company, Accumetrics, Boehringer Ingelheim, BMS, Pfizer, Bayer, and Ferrer. The other authors report no conflicts.
Publisher Copyright:
© 2020 American Heart Association, Inc.
PY - 2020/11/10
Y1 - 2020/11/10
N2 - BACKGROUND: Approximately 15% of saphenous vein grafts (SVGs) occlude during the first year after coronary artery bypass graft surgery (CABG) despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting Surgery) investigated whether ticagrelor added to standard aspirin improves SVG patency at 1 year after CABG.METHODS: In this investigator-initiated, randomized, double-blind, placebo-controlled, multicenter trial, patients with >= 1 SVGs were randomly assigned (1: 1) after CABG to ticagrelor or placebo added to standard aspirin (80 mg or 100 mg). The primary outcome was SVG occlusion at 1 year, assessed with coronary computed tomography angiography, in all patients that had primary outcome imaging available. A generalized estimating equation model was used to perform the primary analysis per SVG. The secondary outcome was 1-year SVG failure, which was a composite of SVG occlusion, SVG revascularization, myocardial infarction in myocardial territory supplied by a SVG, or sudden death.RESULTS: Among 499 randomly assigned patients, the mean age was 67.9 +/- 8.3 years, 87.1% were male, the indication for CABG was acute coronary syndrome in 31.3%, and 95.2% of procedures used cardiopulmonary bypass. Primary outcome imaging was available in 220 patients in the ticagrelor group and 223 patients in the placebo group. The SVG occlusion rate in the ticagrelor group was 10.5% (51 of 484 SVGs) versus 9.1% in the placebo group (43 of 470 SVGs), odds ratio, 1.29 [95% CI, 0.73-2.30]; P=0.38. SVG failure occurred in 35 (14.2%) patients in the ticagrelor group versus 29 (11.6%) patients in the placebo group (odds ratio, 1.22 [95% CI, 0.72-2.05]).CONCLUSIONS: In this randomized, placebo-controlled trial, the addition of ticagrelor to standard aspirin did not reduce SVG occlusion at 1 year after CABG.
AB - BACKGROUND: Approximately 15% of saphenous vein grafts (SVGs) occlude during the first year after coronary artery bypass graft surgery (CABG) despite aspirin use. The POPular CABG trial (The Effect of Ticagrelor on Saphenous Vein Graft Patency in Patients Undergoing Coronary Artery Bypass Grafting Surgery) investigated whether ticagrelor added to standard aspirin improves SVG patency at 1 year after CABG.METHODS: In this investigator-initiated, randomized, double-blind, placebo-controlled, multicenter trial, patients with >= 1 SVGs were randomly assigned (1: 1) after CABG to ticagrelor or placebo added to standard aspirin (80 mg or 100 mg). The primary outcome was SVG occlusion at 1 year, assessed with coronary computed tomography angiography, in all patients that had primary outcome imaging available. A generalized estimating equation model was used to perform the primary analysis per SVG. The secondary outcome was 1-year SVG failure, which was a composite of SVG occlusion, SVG revascularization, myocardial infarction in myocardial territory supplied by a SVG, or sudden death.RESULTS: Among 499 randomly assigned patients, the mean age was 67.9 +/- 8.3 years, 87.1% were male, the indication for CABG was acute coronary syndrome in 31.3%, and 95.2% of procedures used cardiopulmonary bypass. Primary outcome imaging was available in 220 patients in the ticagrelor group and 223 patients in the placebo group. The SVG occlusion rate in the ticagrelor group was 10.5% (51 of 484 SVGs) versus 9.1% in the placebo group (43 of 470 SVGs), odds ratio, 1.29 [95% CI, 0.73-2.30]; P=0.38. SVG failure occurred in 35 (14.2%) patients in the ticagrelor group versus 29 (11.6%) patients in the placebo group (odds ratio, 1.22 [95% CI, 0.72-2.05]).CONCLUSIONS: In this randomized, placebo-controlled trial, the addition of ticagrelor to standard aspirin did not reduce SVG occlusion at 1 year after CABG.
KW - coronary artery bypass
KW - saphenous vein
KW - ticagrelor
KW - vascular patency
KW - SURGERY
KW - GUIDELINES
KW - PREVENTION
KW - PLUS CLOPIDOGREL
KW - ANTIPLATELET THERAPY
KW - ON-PUMP
KW - DISEASE
KW - QUALITY-OF-LIFE
KW - RADIAL-ARTERY
KW - OCCLUSION
U2 - 10.1161/CIRCULATIONAHA.120.050749
DO - 10.1161/CIRCULATIONAHA.120.050749
M3 - Article
C2 - 32862716
SN - 0009-7322
VL - 142
SP - 1799
EP - 1807
JO - Circulation
JF - Circulation
IS - 19
ER -