Dual Antiplatelet Therapy Shows No Benefit Over Aspirin After Cabg In Patients With Acute Coronary Syndrome

Dual antiplatelet therapy (DAPT) was not much effective than aspirin unsocial for nan prevention of awesome adverse cardiovascular events and accrued awesome bleeding successful patients pinch acute coronary syndrome (ACS) who underwent coronary artery bypass grafting (CABG), according to late-breaking investigation presented successful a Hot Line convention coming astatine ESC Congress 20251 and simultaneously published successful New England Journal of Medicine.

ESC Guidelines urge DAPT pinch aspirin positive a P2Y12 inhibitor complete azygous antiplatelet therapy for patients pinch ACS (heart attacks aliases unstable angina) who person undergone CABG.

These recommendations are chiefly based connected extrapolation of information from non-CABG studies, sub-studies of ACS tests and smaller randomised studies pinch surrogate endpoints. Data from larger randomised tests pinch clinically applicable endpoints are lacking. We conducted nan TACSI proceedings to analyse whether 12 months of DAPT pinch ticagrelor and aspirin would trim nan consequence of all-cause decease and cardiovascular events compared pinch aspirin unsocial successful ACS patients aft CABG."

Anders Jeppsson, Principal Investigator, Professor from Sahlgrenska University Hospital, Gothenburg, Sweden

The TACSI proceedings was an investigator-initiated pragmatic, open-label, registry-based randomised proceedings conducted successful each 22 cardiothoracic room centres successful Sweden, Denmark, Norway, Finland and Iceland. Patients undergoing their first isolated CABG were randomised 1:1 wrong 3-14 days to either DAPT (ticagrelor 90 mg doubly regular positive aspirin 75 mg erstwhile daily) aliases aspirin only (75-160 mg regular according to section protocols) for 12 months. The superior efficacy endpoint of awesome adverse cardiovascular events (MACE) was a composite of all-cause death, myocardial infarction, changeable aliases caller coronary revascularisation wrong 12 months. The superior information endpoint was awesome bleeding.

The 2,201 patients included had a mean property of 66 years and 14.4% were women. The superior endpoint of MACE occurred successful a akin proportionality of patients successful each group: 4.8% of patients successful nan DAPT group and 4.6% successful nan aspirin only group (hazard ratio [HR] 1.09; 95% assurance interval [CI] 0.74 to 1.60; log rank p=0.77). Major bleeding was much predominant successful nan DAPT group (4.9% vs. 2.0%; HR 2.50; 95% CI 1.52 to 4.11).

A cardinal secondary endpoint of nett adverse objective events (the superior endpoint positive awesome bleeding) was higher successful nan DAPT group than successful nan aspirin group (9.1% vs. 6.4%; HR 1.45; 95% CI 1.07 to 1.97). A full of 0.7% of patients pinch DAPT and 0.2% pinch aspirin only died during nan first twelvemonth aft randomisation (HR 4.01; 95% CI 0.85 to 18.9).

Concluding, Professor Jeppsson said: "Our 12-month information do not support nan usage of DAPT complete aspirin unsocial successful ACS patients aft CABG, fixed nan deficiency of betterment successful MACE and nan accrued consequence of awesome bleeding. However, further semipermanent follow-up is needed."