Antiplatelet therapy after coronary artery bypass surgery: five year follow-up of randomised DACAB trial

作者：Yunpeng Zhu, Wei Zhang, Arnaldo Dimagli, Lin Han, Zhaoyun Cheng, Ju Mei, Xin Chen, Xiaowei Wang, Yanzai Zhou, Qing Xue, Junlong Hu, Min Tang, Rui Wang, Yuanyuan Song, Lei Kang, Björn Redfors, Mario Gaudino, Qiang Zhao · 发表于：BMJ · 年份：2024 · DOI：10.1136/bmj-2023-075707 · 被引用次数：30 · 研究领域：Antiplatelet Therapy and Cardiovascular Diseases、Cardiac Valve Diseases and Treatments、Acute Myocardial Infarction Research

Abstract Objective To assess the effect of different antiplatelet strategies on clinical outcomes after coronary artery bypass grafting. Design Five year follow-up of randomised Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Grafting (DACAB) trial. Setting Six tertiary hospitals in China; enrolment between July 2014 and November 2015; completion of five year follow-up from August 2019 to June 2021. Participants 500 patients aged 18-80 years (including 91 (18.2%) women) who had elective coronary artery bypass grafting surgery and completed the DACAB trial. Interventions Patients were randomised 1:1:1 to ticagrelor 90 mg twice daily plus aspirin 100 mg once daily (dual antiplatelet therapy; n=168), ticagrelor monotherapy 90 mg twice daily (n=166), or aspirin monotherapy 100 mg once daily (n=166) for one year after surgery. After the first year, antiplatelet therapy was prescribed according to standard of care by treating physicians. Main outcome measures The primary outcome was major adverse cardiovascular events (a composite of all cause death, myocardial infarction, stroke, and coronary revascularisation), analysed using the intention-to-treat principle. Time-to-event analysis was used to compare the risk between treatment groups. Multiple post hoc sensitivity analyses examined the robustness of the findings. Results Follow-up at five years for major adverse cardiovascular events was completed for 477 (95.4%) of 500 patients; 148 patients had major adver...