Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome
(2025) In The New England journal of medicine- Abstract
BACKGROUND: Patients benefit from antiplatelet therapy after coronary-artery bypass grafting (CABG) for an acute coronary syndrome. Whether the addition of ticagrelor to aspirin, as compared with aspirin alone, further reduces the risk of adverse cardiovascular outcomes is unclear.
METHODS: In this open-label, registry-based, clinical trial conducted at 22 Nordic cardiothoracic surgery centers, we randomly assigned patients in a 1:1 ratio to receive either ticagrelor plus aspirin or aspirin alone for 1 year after CABG for an acute coronary syndrome. The primary outcome was a composite of death, myocardial infarction, stroke, or repeat revascularization, evaluated at 1 year. A key secondary outcome was net adverse clinical events,... (More)
BACKGROUND: Patients benefit from antiplatelet therapy after coronary-artery bypass grafting (CABG) for an acute coronary syndrome. Whether the addition of ticagrelor to aspirin, as compared with aspirin alone, further reduces the risk of adverse cardiovascular outcomes is unclear.
METHODS: In this open-label, registry-based, clinical trial conducted at 22 Nordic cardiothoracic surgery centers, we randomly assigned patients in a 1:1 ratio to receive either ticagrelor plus aspirin or aspirin alone for 1 year after CABG for an acute coronary syndrome. The primary outcome was a composite of death, myocardial infarction, stroke, or repeat revascularization, evaluated at 1 year. A key secondary outcome was net adverse clinical events, defined as a primary-outcome event or major bleeding.
RESULTS: A total of 2201 patients were randomly assigned to receive ticagrelor plus aspirin (1104 patients) or aspirin alone (1097 patients). The mean age of the patients was 66 years, and 14.4% were women. A primary-outcome event occurred in 53 patients (4.8%) in the ticagrelor-plus-aspirin group and 50 (4.6%) in the aspirin-alone group (hazard ratio, 1.06; 95% confidence interval [CI], 0.72 to 1.56; P = 0.77). Net adverse clinical events occurred in 9.1% of patients in the ticagrelor-plus-aspirin group and 6.4% in the aspirin-alone group (hazard ratio, 1.45; 95% CI, 1.07 to 1.97). Major bleeding occurred in 4.9% of patients in the ticagrelor-plus-aspirin group and 2.0% in the aspirin-alone group (hazard ratio, 2.50; 95% CI, 1.52 to 4.11).
CONCLUSIONS: Among patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year. (Funded by the Swedish Research Council and others; TACSI ClinicalTrials.gov number, NCT03560310; EudraCT number, 2017-001499-43; EU Clinical Trials number, 2023-508551-40-00.).
(Less)
- author
- Jeppsson, Anders
; James, Stefan
; Moller, Christian H
; Malm, Carl Johan
; Dalén, Magnus
; Vanky, Farkas
; Modrau, Ivy Susanne
; Andersen, Karl
; Anttila, Vesa
; Atroshchenko, Gennady V
; Barbu, Mikael
; Dreifaldt, Mats
; El-Akkawi, Ali Imad
; Friberg, Örjan
; Gudbjartsson, Tomas
; Gunn, Jarmo
; Haaverstad, Rune
; Halonen, Jari
; Hansson, Emma C
; Holm, Jonas
; Husso, Annastiina
; Juvonen, Tatu
; Jakobsen, Øyvind
; Jideus, Lena
; Johannesson, Emilia
LU
; Jonsson Holmdahl, Anna
; Jonsson, Kristjan
; Kolseth, Solveig Moss
; Krasniqi, Lytfi
; Mäkelä, Tuomas
; Mennander, Ari
; Mohagen Krogstad, Lars-Erik
; Rafiq, Sulman
; Raivio, Peter
; Riber, Lars
; Tahir, Aminah
; Thorsen, Carl
; Tønnessen, Theis
; Wahba, Alexander
; Zindovic, Igor
LU
; Pivodic, Aldina
; Nielsen, Susanne J
; Erlinge, David
LU
; Alfredsson, Joakim
and Sartipy, Ulrik
(Less) - author collaboration
- organization
-
- Thoracic Surgery
- Neurological injury in acute type A aortic dissection (research group)
- Heparin bindning protein in cardiothoracic surgery (research group)
- Bleeding disorders and acute typ-A dissection (research group)
- Minimal invasive cardiac surgery in valvular heart disease (research group)
- Teachers at the Medical Programme
- Molecular Cardiology (research group)
- Cardiology
- publishing date
- 2025-09-01
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- The New England journal of medicine
- publisher
- Massachussetts Medical Society
- external identifiers
-
- pmid:40888737
- ISSN
- 0028-4793
- DOI
- 10.1056/NEJMoa2508026
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2025 Massachusetts Medical Society.
- id
- 45623c66-62e6-4db8-bc7d-adeb16957f8d
- date added to LUP
- 2025-09-03 11:12:38
- date last changed
- 2025-09-03 14:47:50
@article{45623c66-62e6-4db8-bc7d-adeb16957f8d,
abstract = {{<p>BACKGROUND: Patients benefit from antiplatelet therapy after coronary-artery bypass grafting (CABG) for an acute coronary syndrome. Whether the addition of ticagrelor to aspirin, as compared with aspirin alone, further reduces the risk of adverse cardiovascular outcomes is unclear.</p><p>METHODS: In this open-label, registry-based, clinical trial conducted at 22 Nordic cardiothoracic surgery centers, we randomly assigned patients in a 1:1 ratio to receive either ticagrelor plus aspirin or aspirin alone for 1 year after CABG for an acute coronary syndrome. The primary outcome was a composite of death, myocardial infarction, stroke, or repeat revascularization, evaluated at 1 year. A key secondary outcome was net adverse clinical events, defined as a primary-outcome event or major bleeding.</p><p>RESULTS: A total of 2201 patients were randomly assigned to receive ticagrelor plus aspirin (1104 patients) or aspirin alone (1097 patients). The mean age of the patients was 66 years, and 14.4% were women. A primary-outcome event occurred in 53 patients (4.8%) in the ticagrelor-plus-aspirin group and 50 (4.6%) in the aspirin-alone group (hazard ratio, 1.06; 95% confidence interval [CI], 0.72 to 1.56; P = 0.77). Net adverse clinical events occurred in 9.1% of patients in the ticagrelor-plus-aspirin group and 6.4% in the aspirin-alone group (hazard ratio, 1.45; 95% CI, 1.07 to 1.97). Major bleeding occurred in 4.9% of patients in the ticagrelor-plus-aspirin group and 2.0% in the aspirin-alone group (hazard ratio, 2.50; 95% CI, 1.52 to 4.11).</p><p>CONCLUSIONS: Among patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year. (Funded by the Swedish Research Council and others; TACSI ClinicalTrials.gov number, NCT03560310; EudraCT number, 2017-001499-43; EU Clinical Trials number, 2023-508551-40-00.).</p>}},
author = {{Jeppsson, Anders and James, Stefan and Moller, Christian H and Malm, Carl Johan and Dalén, Magnus and Vanky, Farkas and Modrau, Ivy Susanne and Andersen, Karl and Anttila, Vesa and Atroshchenko, Gennady V and Barbu, Mikael and Dreifaldt, Mats and El-Akkawi, Ali Imad and Friberg, Örjan and Gudbjartsson, Tomas and Gunn, Jarmo and Haaverstad, Rune and Halonen, Jari and Hansson, Emma C and Holm, Jonas and Husso, Annastiina and Juvonen, Tatu and Jakobsen, Øyvind and Jideus, Lena and Johannesson, Emilia and Jonsson Holmdahl, Anna and Jonsson, Kristjan and Kolseth, Solveig Moss and Krasniqi, Lytfi and Mäkelä, Tuomas and Mennander, Ari and Mohagen Krogstad, Lars-Erik and Rafiq, Sulman and Raivio, Peter and Riber, Lars and Tahir, Aminah and Thorsen, Carl and Tønnessen, Theis and Wahba, Alexander and Zindovic, Igor and Pivodic, Aldina and Nielsen, Susanne J and Erlinge, David and Alfredsson, Joakim and Sartipy, Ulrik}},
issn = {{0028-4793}},
language = {{eng}},
month = {{09}},
publisher = {{Massachussetts Medical Society}},
series = {{The New England journal of medicine}},
title = {{Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome}},
url = {{http://dx.doi.org/10.1056/NEJMoa2508026}},
doi = {{10.1056/NEJMoa2508026}},
year = {{2025}},
}