Ticagrelor, a direct-acting oral P2Y12-receptor antagonist, provides greater and more consistent platelet inhibition than clopidogrel. This study aimed to compare outcomes of ticagrelor plus aspirin versus clopidogrel plus aspirin 1 year after off-pump coronary artery bypass grafting (OPCAB) in patients with clopidogrel resistance.
Between November 2014 and November 2020, 1739 patients underwent OPCAB. Aspirin (100mg daily) and clopidogrel (75mg daily) were administered beginning at aday 1 after surgery. On the 7th postoperative day, the clopidogrel resistance was evaluated by point-of-care assay. Among them, the patients had clopidogrel resistance were enrolled in this study. Investigators divide them into two groups \[A: ticagrelor, B; clopidogrel\]. Primary endpoint was all-cause of mortality 1 year after OPCAB. Secondary endpoint included major adverse cardiovascular events (MACE: cardiac death, myocardial infarction, or stroke). Multivariate Cox regression was used to evaluate predictors of end points.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
204
direct-acting oral P2Y12-receptor antagonist
platelet aggregation inhibitor
Severance Hospital, Yonsei University Health System
Seoul, South Korea
Early graft patency
graft occlusion rate diagnosed by CT exam, at follow-up angiography, grafts were evaluated by use of the usual definition of patency and were assessed for FitzGibbon patency with the A, B, and O classification system in which FitzGibbon A is an excellent/unimpaired graft, Bis an impaired graft with a stenosis \>50% reducing the caliber of the graft to \<50% of the target artery diameter, and O is a completely occluded graft.
Time frame: 1 year after OPCAB
degree of resistance
Platelet reactivity was assayed using the VeriofyNowP2Y12 assay (Accumetrics Inc, San Diego, CA) which is a cartridge-based assay that specifically measures the direct effects of clopidogrel on the platelet P2Y12 receptor. The results are expressed as P2Y12 reaction units (PRUs) for clopidogrel. The cut-off PRU value was 188 PRU and the details were described previous study.
Time frame: 7 day after surgery
Number of patients with resistance with clopidogrel as assessed by VeriofyNowP2Y12 assay
The cut-off PRU value was 188 PRU
Time frame: 7 day after surgery
Mediastinal Bleeding
total drainage counts (ml) from median tubes
Time frame: up to 4 weeks
Total hospital day from admission to discharge
Time frame: up to 4 weeks
rate of postoperative stroke of myocardial infarction
Time frame: Participants will be followed during 1 years from operation
rate of postoperative morbidity/ mortality
Time frame: Participants will be followed during 5 years from operation
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