To evaluate the noninferiority of 3 months of ticagrelor-based dual antiplatelet therapy (DAPT) compared to 12 months in patients undergoing elective coronary artery bypass grafting (CABG) with saphenous vein grafts (SVG), focusing on graft occlusion rates and bleeding risks.
Key Findings:
3-month DAPT met the noninferiority criterion for SVG occlusion compared to 12-month DAPT (10.8% vs 11.2%, p-value needed).
Clinically relevant bleeding occurred in 8% of the 3-month group vs 13% in the 12-month group (p-value needed).
Major adverse cardiovascular and cerebrovascular events occurred in 2.3% of the 3-month group vs 2.7% in the 12-month group (not powered for significance).
Interpretation:
The findings suggest that a 3-month ticagrelor-based DAPT strategy may effectively reduce bleeding risk without compromising graft occlusion rates in selected CABG patients, potentially influencing clinical practice.
Limitations:
Over 11% of patients did not fully adhere to the assigned intervention, which may affect outcomes.
80% of participants were enrolled from a single center in China, limiting generalizability to other populations.
Patients unable to tolerate early postoperative DAPT were excluded, potentially introducing selection bias and affecting the applicability of results.
Conclusion:
The study supports a shorter ticagrelor-based DAPT strategy for selected patients undergoing elective CABG with SVGs, but findings may not apply to all antiplatelet regimens or patient populations, highlighting the need for further research.
