Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With Chronic Kidney Disease.
Aged
Aged, 80 and over
Aspirin
/ therapeutic use
Coronary Artery Bypass
/ methods
Coronary Artery Disease
/ complications
Double-Blind Method
Female
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors
/ therapeutic use
Postoperative Care
/ methods
Renal Insufficiency, Chronic
/ complications
Stroke
/ etiology
Ticagrelor
/ therapeutic use
Treatment Outcome
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
06
11
2020
revised:
19
01
2021
accepted:
22
03
2021
pubmed:
6
4
2021
medline:
4
2
2022
entrez:
5
4
2021
Statut:
ppublish
Résumé
The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery remains unknown. This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor vs aspirin in patients with and patients without CKD. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), namely, the composite of cardiovascular death, stroke, myocardial infarction, or revascularization at 1 year after coronary artery bypass graft surgery. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding. Chronic kidney disease was present in 276 of 1843 randomized patients (15%). Patients with CKD vs patients without CKD had higher 1-year rates of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval [CI], 1.12 to 2.39; P = .01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95% CI, 1.03 to 3.28; P = .04). The 1-year rate of MACCE was increased with ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95% CI, 1.08 to 4.30; P = .03), but not in patients without CKD (8.5% vs 8.1%, HR 1.05; 95% CI, 0.74 to 1.49; P = .79; P Among patients with CKD and coronary artery bypass graft surgery, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared with those who received aspirin.
Sections du résumé
BACKGROUND
The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery remains unknown.
METHODS
This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor vs aspirin in patients with and patients without CKD. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), namely, the composite of cardiovascular death, stroke, myocardial infarction, or revascularization at 1 year after coronary artery bypass graft surgery. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding.
RESULTS
Chronic kidney disease was present in 276 of 1843 randomized patients (15%). Patients with CKD vs patients without CKD had higher 1-year rates of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval [CI], 1.12 to 2.39; P = .01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95% CI, 1.03 to 3.28; P = .04). The 1-year rate of MACCE was increased with ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95% CI, 1.08 to 4.30; P = .03), but not in patients without CKD (8.5% vs 8.1%, HR 1.05; 95% CI, 0.74 to 1.49; P = .79; P
CONCLUSIONS
Among patients with CKD and coronary artery bypass graft surgery, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared with those who received aspirin.
Identifiants
pubmed: 33819474
pii: S0003-4975(21)00590-7
doi: 10.1016/j.athoracsur.2021.03.061
pii:
doi:
Substances chimiques
Platelet Aggregation Inhibitors
0
Ticagrelor
GLH0314RVC
Aspirin
R16CO5Y76E
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
554-562Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.