Influence of lipoproteins and antiplatelet agents on vein graft patency 1 year after coronary artery bypass grafting

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 163; no. 3; pp. 1030 - 1039.e4
• Main Authors: Zhu, Jiaxi, Zhu, Yunpeng, Zhang, Minlu, Xue, Qing, Hu, Junlong, Liu, Hao, Wang, Rui, Wang, Xiaowei, Zhao, Qiang
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2022
• Subjects: Aged; aspirin; Aspirin - adverse effects; Aspirin - therapeutic use; Biomarkers - blood; China; Cholesterol, LDL - blood; Coronary Artery Bypass - adverse effects; coronary artery bypass grafting; Coronary Artery Disease - blood; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary Artery Disease - surgery; Dual Anti-Platelet Therapy; Female; Graft Occlusion, Vascular - diagnostic imaging; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Graft Occlusion, Vascular - prevention & control; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; low-density lipoprotein cholesterol; Male; Middle Aged; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Risk Assessment; Risk Factors; Thrombosis - etiology; Thrombosis - physiopathology; Thrombosis - prevention & control; ticagrelor; Ticagrelor - adverse effects; Ticagrelor - therapeutic use; Time Factors; Treatment Outcome; Vascular Patency - drug effects; China; LDL-C; MACE; low-density lipoprotein cholesterol; CI; aspirin; ticagrelor; DACAB; ORadj; CABG; coronary artery bypass grafting
• ISSN: 0022-5223; 1097-685X; 1097-685X
• DOI: 10.1016/j.jtcvs.2020.03.039

It remains unclear whether aggressive low-density lipoprotein cholesterol (LDL-C) management (<1.8 mmol/L) can slow the process of vein graft stenosis. This study aimed to explore the impact of baseline LDL-C levels on vein graft patency in patients on ticagrelor with or without aspirin 1 year after coronary artery bypass grafting (CABG). This was a post hoc analysis of the DACAB (Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Graft Surgery) trial (NCT02201771), a randomized controlled trial (ticagrelor + aspirin or ticagrelor vs aspirin) of patients undergoing CABG in China. The study subjects were stratified as LDL-low (baseline LDL-C <1.8 mmol/L, 148 patients with 430 vein grafts) versus LDL-high (baseline LDL-C ≥1.8 mmol/L, 352 patients with 1030 vein grafts). The primary outcome was the 1-year vein graft patency (Fitzgibbon grade A) assessed by coronary computed tomographic angiography or coronary angiography. Baseline/1-year LDL-C were 1.4/1.6 and 2.6/2.4 mmol/L in the LDL-low and LDL-high subgroups, respectively. Regardless of antiplatelet regimen, no significant inter-subgroup difference was observed for 1-year graft patency (LDL-low: 83.8% [359/430 grafts]; LDL-high: 82.3% [848/1030 grafts]; adjusted OR for non-patency [ORadj], 0.96; 95% confidence interval [CI], 0.62-1.50, P = .857). For both subgroups, the 1-year graft patency rates were greater with ticagrelor + aspirin versus aspirin (LDL-low: ORadj, 0.41; 95% CI, 0.17-0.97; LDL-high: ORadj, 0.38; 95% CI, 0.20-0.71; inter P = .679). In general, baseline LDL-C is not associated with 1-year vein graft patency after CABG. Regardless of the baseline LDL-C levels, ticagrelor + aspirin was superior to aspirin alone in maintaining vein graft patency. The primary factor causing early vein graft disease might not be atherosclerosis but thrombosis. [Display omitted]