초록접수 현황
| 17F-129 | 구연 발표 |
Dual Antiplatelet Therapy after Coronary Artery Bypass Grafting in Acute Coronary Syndrome; A Real-world Comparison between Clopidogrel and Ticagrelor
Hyoung Woo Chang, Hee Jung Kim, Jae Suk Yoo, Dong Jin Kim, Kwang Ree Cho
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Republic of Korea
Purpose : In dual antiplatelet therapy (DAPT) for patients with non-ST-elevation acute coronary syndrome (NSTE-ACS), ticagrelor is preferred to clopidogrel in patients undergoing coronary stenting due to its higher potency and better clinical outcomes. We compared the results of postoperative DAPT in patients who had undergone CABG for NSTE-ACS.
Methods : From 2013 to 2016, a total of 278 patients underwent off-pump CABG due to NSTE-ACS, and 273 received DAPT postoperatively; ASA+CPD group (n=100, 37%) vs ASA+TCG group (n=173, 63%). Total arterial revascularization was achieved in 268 patients (98%). Our policy was to continue using aspirin alone after maintaining DAPT for 3 months after CABG.
Results : For 1 year postoperatively, 11/273 patients (4%) experienced the composite outcome of major adverse cardiovascular event (MACE) and major bleeding; ASA+CPD group (n=5, 5.0%) vs ASA+TCG group (n=6, 3.5%). There were 4 patients with MACE (2 in ASA+CPD vs 2 in ASA+TCG group), and 8 patients with major bleeding (4 in ASA+CPD vs 4 in ASA+TCG group) without statistically significant difference between groups. In the risk factor analysis for composite outcome (MACE + major bleeding), using ticagrelor (vs clopidogrel) was not a risk factor; OR 0.7, 95% CI 0.2-2.3, P=0.51. Lower body surface area (BSA) was associated with lower risk of composite outcome; OR 0.01, 95% CI 0.0-0.6, P=0.01.
Conclusion : When performing CABG with arterial grafts, despite the concern on increased bleeding risk of ticagrelor, ASA+TCG regimen showed comparable incidence of MACE or major bleeding with ASA+CPD in patients with NSTE-ACS.
Methods : From 2013 to 2016, a total of 278 patients underwent off-pump CABG due to NSTE-ACS, and 273 received DAPT postoperatively; ASA+CPD group (n=100, 37%) vs ASA+TCG group (n=173, 63%). Total arterial revascularization was achieved in 268 patients (98%). Our policy was to continue using aspirin alone after maintaining DAPT for 3 months after CABG.
Results : For 1 year postoperatively, 11/273 patients (4%) experienced the composite outcome of major adverse cardiovascular event (MACE) and major bleeding; ASA+CPD group (n=5, 5.0%) vs ASA+TCG group (n=6, 3.5%). There were 4 patients with MACE (2 in ASA+CPD vs 2 in ASA+TCG group), and 8 patients with major bleeding (4 in ASA+CPD vs 4 in ASA+TCG group) without statistically significant difference between groups. In the risk factor analysis for composite outcome (MACE + major bleeding), using ticagrelor (vs clopidogrel) was not a risk factor; OR 0.7, 95% CI 0.2-2.3, P=0.51. Lower body surface area (BSA) was associated with lower risk of composite outcome; OR 0.01, 95% CI 0.0-0.6, P=0.01.
Conclusion : When performing CABG with arterial grafts, despite the concern on increased bleeding risk of ticagrelor, ASA+TCG regimen showed comparable incidence of MACE or major bleeding with ASA+CPD in patients with NSTE-ACS.
책임저자: Kwang Ree Cho
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Republic of Korea
발표자: Hyoung Woo Chang, E-mail : chang.hyoungwoo@gmail.com