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Ticagrelor or aspirin after coronary artery bypass in patients with chronic kidney disease
Sandner, Sigrid E.
Schunkert, Heribert
Kastrati, Adnan
Milojević, Milan
Böning, Andreas
Zimpfer, Daniel
Zellmer, Stephan
Wiedemann, Dominik
Laufer, Günther
Von Scheidt, Moritz
TiCAB Investigators
BACKGROUND: The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass grafting (CABG) remains unknown. METHODS: This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor versus aspirin in patients with or without CKD. Primary endpoint was the composite of cardiovascular death, stroke, myocardial infarction or revascularization (MACCE) at 1 year after CABG. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding. Results: CKD was present in 276 of 1,843 randomized patients (15.0%). Patients with CKD versus those without CKD had higher 1-year rates of MACCE (13.0% vs. 8.3%, HR 1.63, 95% CI 1.12-2.39, P=0.01) and major bleeding (5.6% vs. 3.1%, HR 1.84, 95% CI 1.03-3.28, P=0.04). The 1-year rate of MACCE was increased with ticagrelor versus aspirin in patients with CKD (18.2% vs. 8.9%, HR 2.15, 95% CI 1.08-4.30, P=0.03), but not in patients without CKD (8.5% vs. 8.1%, HR 1.05, 95% CI 0.74-1.49, P=0.79) (Pinteraction=0.067). There was no difference in the 1-year rate of major bleeding with ticagrelor versus aspirin in patients with CKD (6.6% vs. 4.7%, HR 1.44, 95% CI 0.52-3.97, P=0.48) and without CKD (3.3% vs. 2.9%, HR 1.14, 95% CI 0.64-2.01, P=0.65). CONCLUSIONS: In patients with CKD and CABG, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared to those who received aspirin.
Journal Pre-Proof
engleski
2022
© All rights reserved
Key words: ticagrelor, aspirin, coronary artery bypass
10.1016/j.athoracsur.2021.03.061
129074441