المؤلفون: Sandner, Sigrid^1,2 (AUTHOR), Redfors, Björn³ (AUTHOR), Angiolillo, Dominick J.⁴ (AUTHOR), Audisio, Katia⁵ (AUTHOR), Fremes, Stephen E.^6,7 (AUTHOR), Janssen, Paul W.A.⁸ (AUTHOR), Kulik, Alexander⁹ (AUTHOR), Mehran, Roxana¹⁰ (AUTHOR), Peper, Joyce⁸ (AUTHOR), Ruel, Marc¹¹ (AUTHOR), Saw, Jacqueline^12,13 (AUTHOR), Soletti, Giovanni Jr⁵ (AUTHOR), Starovoytov, Andrew¹² (AUTHOR), ten Berg, Jurrien M.⁸ (AUTHOR), Willemsen, Laura M.⁸ (AUTHOR), Zhao, Qiang¹⁴ (AUTHOR), Zhu, Yunpeng¹⁴ (AUTHOR), Gaudino, Mario⁵ (AUTHOR) mfg9004@med.cornell.edu

المصدر: JAMA: Journal of the American Medical Association. 8/9/2022, Vol. 328 Issue 6, p554-562. 9p.

مصطلحات موضوعية: *SAPHENOUS vein, *RESEARCH, *CORONARY artery bypass, *CLINICAL trials, *META-analysis, *RESEARCH methodology, *SYSTEMATIC reviews, *SURGICAL complications, *MEDICAL care, *EVALUATION research, *TREATMENT effectiveness, *VASCULAR grafts, *CARDIOVASCULAR system, *COMPARATIVE studies, *PLATELET aggregation inhibitors, *ASPIRIN, *HEMORRHAGE, PREVENTION of surgical complications

مستخلص: Importance: The role of ticagrelor with or without aspirin after coronary artery bypass graft surgery remains unclear.Objective: To compare the risks of vein graft failure and bleeding associated with ticagrelor dual antiplatelet therapy (DAPT) or ticagrelor monotherapy vs aspirin among patients undergoing coronary artery bypass graft surgery.Data Sources: MEDLINE, Embase, and Cochrane Library databases from inception to June 1, 2022, without language restriction.Study Selection: Randomized clinical trials (RCTs) comparing the effects of ticagrelor DAPT or ticagrelor monotherapy vs aspirin on saphenous vein graft failure.Data Extraction and Synthesis: Individual patient data provided by each trial were synthesized into a combined data set for independent analysis. Multilevel logistic regression models were used.Main Outcomes and Measures: The primary analysis assessed the incidence of saphenous vein graft failure per graft (primary outcome) in RCTs comparing ticagrelor DAPT with aspirin. Secondary outcomes were saphenous vein graft failure per patient and Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding events. A supplementary analysis included RCTs comparing ticagrelor monotherapy with aspirin.Results: A total of 4 RCTs were included in the meta-analysis, involving 1316 patients and 1668 saphenous vein grafts. Of the 871 patients in the primary analysis, 435 received ticagrelor DAPT (median age, 67 years [IQR, 60-72 years]; 65 women [14.9%]; 370 men [85.1%]) and 436 received aspirin (median age, 66 years [IQR, 61-73 years]; 63 women [14.5%]; 373 men [85.5%]). Ticagrelor DAPT was associated with a significantly lower incidence of saphenous vein graft failure (11.2%) per graft than was aspirin (20%; difference, -8.7% [95% CI, -13.5% to -3.9%]; OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001) and was associated with a significantly lower incidence of saphenous vein graft failure per patient (13.2% vs 23.0%, difference, -9.7% [95% CI, -14.9% to -4.4%]; OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001). Ticagrelor DAPT (22.1%) was associated with a significantly higher incidence of BARC type 2, 3, or 5 bleeding events than was aspirin (8.7%; difference, 13.3% [95% CI, 8.6% to 18.0%]; OR, 2.98 [95% CI, 1.99 to 4.47]; P < .001), but not BARC type 3 or 5 bleeding events (1.8% vs 1.8%, difference, 0% [95% CI, -1.8% to 1.8%]; OR, 1.00 [95% CI, 0.37 to 2.69]; P = .99). Compared with aspirin, ticagrelor monotherapy was not significantly associated with saphenous vein graft failure (19.3% vs 21.7%, difference, -2.6% [95% CI, -9.1% to 3.9%]; OR, 0.86 [95% CI, 0.58 to 1.27]; P = .44) or BARC type 2, 3, or 5 bleeding events (8.9% vs 7.3%, difference, 1.7% [95% CI, -2.8% to 6.1%]; OR, 1.25 [95% CI, 0.69 to 2.29]; P = .46).Conclusions and Relevance: Among patients undergoing coronary artery bypass graft surgery, adding ticagrelor to aspirin was associated with a significantly decreased risk of vein graft failure. However, this was accompanied by a significantly increased risk of clinically important bleeding. [ABSTRACT FROM AUTHOR]

المؤلفون: Wollner, Gregor, Zimpfer, Daniel, Manduric, Marina, Laufer, Günther, Rieger, Armin, Sandner, Sigrid E.

المصدر: Journal of Cardiac Surgery; Oct2020, Vol. 35 Issue 10, p2543-2549, 7p, 5 Charts, 3 Graphs

مصطلحات موضوعية: HIV infections, CORONARY artery bypass, HIGHLY active antiretroviral therapy, HIV infection complications, STROKE, SURGICAL complications, CARDIOVASCULAR diseases, RETROSPECTIVE studies, MYOCARDIAL infarction, TREATMENT effectiveness, CORONARY artery disease, DISEASE complications

الشركة/الكيان: MEDIZINISCHE Universitat Wien

مستخلص: Background: With early and effective antiretroviral therapy and improved survival for persons living with human immunodeficiency virus infection (PLHIV), this patient population now faces an increasingly elevated risk of cardiovascular disease. However, the data on outcomes after coronary artery bypass grafting (CABG) for revascularization of coronary artery disease (CAD) in HIV+ patients is limited.Methods: We conducted a retrospective analysis of 16 patients undergoing isolated CABG at the Medical University of Vienna from 2005 to 2018, who were HIV+ on admission. The primary endpoint of the study was survival. Secondary endpoints included the components of major adverse cardiac and cerebrovascular events (MACCE): cardiovascular death, stroke, myocardial infarction (MI), and repeat revascularization.Results: Patients were followed for a median of 49 months (range, 7-142 months). Survival was 100% and 90% at 1 and 3 years after CABG, respectively. There were no strokes. MI and subsequent repeat revascularization were observed in two patients.Conclusion: CABG provides excellent short- and midterm survival and freedom from MACCE in HIV+ patients with CAD requiring revascularization. [ABSTRACT FROM AUTHOR]

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