Key result
Baseline LDL-C <1.8 mmol/L is not linked to improved 1-year vein graft patency after CABG.
Why the study?
It remained unclear whether aggressive LDL-C management (<1.8 mmol/L) can slow vein graft stenosis in patients on ticagrelor with or without aspirin after CABG.
Does baseline LDL-C level or dual antiplatelet therapy with ticagrelor and aspirin improve 1-year vein graft patency in patients after CABG?
RCT (n=500)
Does baseline LDL-C level or dual antiplatelet therapy with ticagrelor and aspirin improve 1-year vein graft patency in patients after CABG?
Early vein graft patency at 1 year after CABG is driven more by antithrombotic therapy (ticagrelor + aspirin) than by baseline LDL-C levels, suggesting thrombosis rather than atherosclerosis is the primary mechanism of early graft failure.
OBJECTIVE 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). METHODS 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. RESULTS 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). CONCLUSIONS 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.
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Zhu et al. (2020) conducted an RCT in Coronary artery bypass grafting (n=500). Baseline LDL-C <1.8 mmol/L vs. Baseline LDL-C ≥1.8 mmol/L was evaluated on 1-year vein graft patency (Fitzgibbon grade A) assessed by coronary computed tomographic angiography or coronary angiography (OR 0.96, 95% CI 0.62-1.50, p=.857). Baseline LDL-C <1.8 mmol/L was not associated with improved 1-year vein graft patency after CABG compared to LDL-C ≥1.8 mmol/L (83.8% vs 82.3%; OR 0.96; 95% CI 0.62-1.50; P=0.857).
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