Extent of coronary artery disease and clinical outcomes with ticagrelor monotherapy versus aspirin after coronary artery bypass grafting: insights from the TiCAB trial
Year: 2025
Type: article
Abstract: OBJECTIVES: Patients with extensive coronary artery disease (CAD) have a higher risk of cardiovascular events. This post hoc analysis of the Ticagrelor in CABG (TiCAB) trial examined the association of ticagrelor monotherapy versus aspirin with clinical outcomes after coronary artery bypass grafting (CABG) in relation to the extent of CAD. METHODS: The TiCAB trial randomized CABG patients to ticagrelor (90 mg twice daily) or aspirin (100 mg daily) for 12 months. Patients were stratified by SYNTAX score terciles: low (≤22), intermediate (23-32) and high (≥33). The primary end-point was major adverse cardiac and cerebrovascular events (MACCE) at 12 months, including cardiovascular death, myocardial infarction, stroke or repeat revascularization. Secondary end-points included individual MACCE components and major bleeding events. Cox proportional hazards models were used to assess treatment effects. RESULTS: Among 752 patients, 33.4% had low, 36.0% intermediate and 30.6% high SYNTAX scores (median 26.5 [20.0-33.0]). MACCE rates were similar across groups (low: 7.8%; intermediate: 9.2%; high: 8.8%; P = 0.87), though the incidence of repeat revascularization differed significantly among SYNTAX score groups (P = 0.02). Ticagrelor did not show a significant MACCE benefit over aspirin in any SYNTAX score group (low: HR 2.27, 95% CI 0.87-5.94; intermediate: HR 1.02, 95% CI 0.46-2.27; high: HR 1.76, 95% CI 0.70-4.46; Pint=0.41). Secondary outcomes, including bleeding, aligned with overall trial results. CONCLUSIONS: This analysis did not find a differential benefit of ticagrelor versus aspirin across CAD complexity levels as measured by the SYNTAX score. Further studies are warranted to refine antiplatelet strategies for patients with complex CAD undergoing CABG.
Authors: Melanie Arnreiter, Moritz von Scheidt, Johannes M Albes, Tim Attmann, Andreas Boening, Yeong-Hoon Choi, Lenard Conradi, Bernhard C Danner, Andreas Fach, Ivar Friedrich, Herko Grubitzsch, Roland Heck, Alexander Joost, Christoph Knosalla, Martin Misfeld, Martin Oberhoffer, Julia Riebandt, Andreas Schaefer, Matthias Siepe, Thomas Walther, Gerhard Wimmer-Greinecker, Uwe Zeymer, Heribert Schunkert, Adnan Kastrati, Sigrid Sandner
Institutions: Medical University of Vienna, TUM Klinikum, German Centre for Cardiovascular Research, Deutsches Herzzentrum München, Technical University of Munich, Universitätsklinikum Brandenburg an der Havel, Immanuel Klinikum Bernau, University Hospital Schleswig-Holstein, Universitätsklinikum Gießen und Marburg, Kerckhoff Klinik, Universität Hamburg, University Medical Center Hamburg-Eppendorf, Universitätsmedizin Göttingen, University of Göttingen, Krankenhaus der Barmherzigen Brüder Trier, Deutsches Herzzentrum der Charité, Charité - Universitätsmedizin Berlin, University of Lübeck, Royal Prince Alfred Hospital, Johannes Gutenberg University Mainz, University Medical Center of the Johannes Gutenberg University Mainz, University of Bern, University Hospital of Bern, Goethe University Frankfurt, University Hospital Frankfurt, Stiftung Institut für Herzinfarktforschung, Klinikum Ludwigshafen
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,699
OpenAlex ID: W4410708384