Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With Chronic Kidney Disease

TiCAB Investigators; Sigrid E. Sandner; Heribert Schunkert; Adnan Kastrati; Milan Milojevic; Andreas Böning; Daniel Zimpfer; Stephan Zellmer; Dominik Wiedemann; Günther Laufer; Moritz von Scheidt

doi:10.1016/j.athoracsur.2021.03.061

Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With Chronic Kidney Disease

TiCAB Investigators, Sigrid E. Sandner^*, Heribert Schunkert, Adnan Kastrati, Milan Milojevic, Andreas Böning, Daniel Zimpfer, Stephan Zellmer, Dominik Wiedemann, Günther Laufer, Moritz von Scheidt

^*Corresponding author for this work

Cardiothoracic Surgery

Research output: Contribution to journal › Article › Academic › peer-review

5 Citations (Scopus)

Abstract

Background: The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery remains unknown. Methods: This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor vs aspirin in patients with and patients without CKD. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), namely, the composite of cardiovascular death, stroke, myocardial infarction, or revascularization at 1 year after coronary artery bypass graft surgery. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding. Results: Chronic kidney disease was present in 276 of 1843 randomized patients (15%). Patients with CKD vs patients without CKD had higher 1-year rates of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval [CI], 1.12 to 2.39; P =.01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95% CI, 1.03 to 3.28; P =.04). The 1-year rate of MACCE was increased with ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95% CI, 1.08 to 4.30; P =.03), but not in patients without CKD (8.5% vs 8.1%, HR 1.05; 95% CI, 0.74 to 1.49; P =.79; P_interaction =.067). There was no difference in the 1-year rate of major bleeding with ticagrelor vs aspirin in patients with CKD (6.6% vs 4.7%, HR 1.44; 95% CI, 0.52 to 3.97; P =.48) and patients without CKD (3.3% vs 2.9%, HR 1.14; 95% CI, 0.64 to 2.01; P =.65). Conclusions: Among patients with CKD and coronary artery bypass graft surgery, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared with those who received aspirin.

Original language	English
Pages (from-to)	554-562
Number of pages	9
Journal	Annals of Thoracic Surgery
Volume	113
Issue number	2
Early online date	2 Apr 2021
DOIs	https://doi.org/10.1016/j.athoracsur.2021.03.061
Publication status	Published - 1 Feb 2022

Bibliographical note

Funding Information:
The TiCAB trial was sponsored by Deutsches Herzzentrum München, Germany. Financial support for the trial was provided by AstraZeneca. Dr von Scheidt received funding from the Clinician Scientist Excellence Program of the German Center for Cardiovascular Research (DZHK), the German Society of Cardiology (DGK), and the German Heart Foundation (Deutsche Herzstiftung e.V.). Dr Sandner received research grants from Vascular Graft Solutions. Dr Schunkert received research grants from Astra Zeneca.

Publisher Copyright:
© 2022 The Society of Thoracic Surgeons

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@article{db2688f88a79407692b7907319525cd1,

title = "Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With Chronic Kidney Disease",

abstract = "Background: The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery remains unknown. Methods: This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor vs aspirin in patients with and patients without CKD. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), namely, the composite of cardiovascular death, stroke, myocardial infarction, or revascularization at 1 year after coronary artery bypass graft surgery. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding. Results: Chronic kidney disease was present in 276 of 1843 randomized patients (15%). Patients with CKD vs patients without CKD had higher 1-year rates of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval [CI], 1.12 to 2.39; P =.01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95% CI, 1.03 to 3.28; P =.04). The 1-year rate of MACCE was increased with ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95% CI, 1.08 to 4.30; P =.03), but not in patients without CKD (8.5% vs 8.1%, HR 1.05; 95% CI, 0.74 to 1.49; P =.79; Pinteraction =.067). There was no difference in the 1-year rate of major bleeding with ticagrelor vs aspirin in patients with CKD (6.6% vs 4.7%, HR 1.44; 95% CI, 0.52 to 3.97; P =.48) and patients without CKD (3.3% vs 2.9%, HR 1.14; 95% CI, 0.64 to 2.01; P =.65). Conclusions: Among patients with CKD and coronary artery bypass graft surgery, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared with those who received aspirin.",

author = "{TiCAB Investigators} and Sandner, {Sigrid E.} and Heribert Schunkert and Adnan Kastrati and Milan Milojevic and Andreas B{\"o}ning and Daniel Zimpfer and Stephan Zellmer and Dominik Wiedemann and G{\"u}nther Laufer and {von Scheidt}, Moritz",

note = "Funding Information: The TiCAB trial was sponsored by Deutsches Herzzentrum M{\"u}nchen, Germany. Financial support for the trial was provided by AstraZeneca. Dr von Scheidt received funding from the Clinician Scientist Excellence Program of the German Center for Cardiovascular Research (DZHK), the German Society of Cardiology (DGK), and the German Heart Foundation (Deutsche Herzstiftung e.V.). Dr Sandner received research grants from Vascular Graft Solutions. Dr Schunkert received research grants from Astra Zeneca. Publisher Copyright: {\textcopyright} 2022 The Society of Thoracic Surgeons",

year = "2022",

month = feb,

day = "1",

doi = "10.1016/j.athoracsur.2021.03.061",

language = "English",

volume = "113",

pages = "554--562",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier Inc.",

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TY - JOUR

T1 - Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With Chronic Kidney Disease

AU - TiCAB Investigators

AU - Sandner, Sigrid E.

AU - Schunkert, Heribert

AU - Kastrati, Adnan

AU - Milojevic, Milan

AU - Böning, Andreas

AU - Zimpfer, Daniel

AU - Zellmer, Stephan

AU - Wiedemann, Dominik

AU - Laufer, Günther

AU - von Scheidt, Moritz

N1 - Funding Information: The TiCAB trial was sponsored by Deutsches Herzzentrum München, Germany. Financial support for the trial was provided by AstraZeneca. Dr von Scheidt received funding from the Clinician Scientist Excellence Program of the German Center for Cardiovascular Research (DZHK), the German Society of Cardiology (DGK), and the German Heart Foundation (Deutsche Herzstiftung e.V.). Dr Sandner received research grants from Vascular Graft Solutions. Dr Schunkert received research grants from Astra Zeneca. Publisher Copyright: © 2022 The Society of Thoracic Surgeons

PY - 2022/2/1

Y1 - 2022/2/1

N2 - Background: The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery remains unknown. Methods: This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor vs aspirin in patients with and patients without CKD. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), namely, the composite of cardiovascular death, stroke, myocardial infarction, or revascularization at 1 year after coronary artery bypass graft surgery. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding. Results: Chronic kidney disease was present in 276 of 1843 randomized patients (15%). Patients with CKD vs patients without CKD had higher 1-year rates of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval [CI], 1.12 to 2.39; P =.01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95% CI, 1.03 to 3.28; P =.04). The 1-year rate of MACCE was increased with ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95% CI, 1.08 to 4.30; P =.03), but not in patients without CKD (8.5% vs 8.1%, HR 1.05; 95% CI, 0.74 to 1.49; P =.79; Pinteraction =.067). There was no difference in the 1-year rate of major bleeding with ticagrelor vs aspirin in patients with CKD (6.6% vs 4.7%, HR 1.44; 95% CI, 0.52 to 3.97; P =.48) and patients without CKD (3.3% vs 2.9%, HR 1.14; 95% CI, 0.64 to 2.01; P =.65). Conclusions: Among patients with CKD and coronary artery bypass graft surgery, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared with those who received aspirin.

AB - Background: The optimal antiplatelet therapy for patients with chronic kidney disease (CKD) undergoing coronary artery bypass graft surgery remains unknown. Methods: This post hoc analysis of the Ticagrelor in Coronary Artery Bypass (TiCAB) trial examined the efficacy and safety of ticagrelor vs aspirin in patients with and patients without CKD. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), namely, the composite of cardiovascular death, stroke, myocardial infarction, or revascularization at 1 year after coronary artery bypass graft surgery. Secondary endpoints included individual components of the primary endpoint, all-cause death, and major bleeding. Results: Chronic kidney disease was present in 276 of 1843 randomized patients (15%). Patients with CKD vs patients without CKD had higher 1-year rates of MACCE (13% vs 8.3%, hazard ratio [HR] 1.63; 95% confidence interval [CI], 1.12 to 2.39; P =.01) and major bleeding (5.6% vs 3.1%, HR 1.84; 95% CI, 1.03 to 3.28; P =.04). The 1-year rate of MACCE was increased with ticagrelor vs aspirin in patients with CKD (18.2% vs 8.9%, HR 2.15; 95% CI, 1.08 to 4.30; P =.03), but not in patients without CKD (8.5% vs 8.1%, HR 1.05; 95% CI, 0.74 to 1.49; P =.79; Pinteraction =.067). There was no difference in the 1-year rate of major bleeding with ticagrelor vs aspirin in patients with CKD (6.6% vs 4.7%, HR 1.44; 95% CI, 0.52 to 3.97; P =.48) and patients without CKD (3.3% vs 2.9%, HR 1.14; 95% CI, 0.64 to 2.01; P =.65). Conclusions: Among patients with CKD and coronary artery bypass graft surgery, those who received ticagrelor had a higher incidence of MACCE but a similar incidence of major bleeding compared with those who received aspirin.

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U2 - 10.1016/j.athoracsur.2021.03.061

DO - 10.1016/j.athoracsur.2021.03.061

M3 - Article

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AN - SCOPUS:85116701470

SN - 0003-4975

VL - 113

SP - 554

EP - 562

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

IS - 2

ER -

Ticagrelor or Aspirin After Coronary Artery Bypass in Patients With Chronic Kidney Disease

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