Overview

The purpose of this study is to compare the effect of ticagrelor plus low-dose aspirin versus low-dose aspirin alone in patients with chronic coronary disease undergoing coronary artery bypass grafting.

Eligibility

Inclusion Criteria:

• Age ≥18 years
• Elective first-time CABG with use of ≥1 saphenous vein graft;
• Ability to sign informed consent and comply with all study procedures, including follow-up for at least 5 years.

Exclusion Criteria:

• Any indication for dual antiplatelet therapy, including
  • Acute/recent (within 1 year) ACS (NSTE-ACS or STEMI)
  • Recent PCI requiring continuation of dual antiplatelet therapy after CABG
• Current or anticipated use of oral anticoagulation;
• Paroxysmal, persistent or permanent atrial fibrillation;
• Any concomitant cardiac or non-cardiac procedure;
• Planned cardiac or non-cardiac surgery within one year;
• Preoperative end-organ dysfunction (dialysis, moderate to severe liver failure, respiratory failure), cancer or other non-cardiac comorbidity with a life expectancy <5 years;
• Inability to use the saphenous vein;
• Contraindications to the use of aspirin;
• Contraindications to the use of ticagrelor, including
  • Known hypersensitivity to ticagrelor
  • Active pathological bleeding (including, but not limited to gastrointestinal or intracranial bleeding)
  • History of intracranial hemorrhage
  • Concomitant therapy with strong CYP3A4 inhibitors (eg ketoconazole, clarithromycin, nefazodone, ritonavir, atazanavir)
• Inability to undergo coronary computed tomographic angiography (CCTA);
• Participating in another investigational device or drug study;
• Women of childbearing potential
• Any major perioperative complication including, but not limited to, stroke, TIA, MI, CABG-related bleeding (BARC type 4), sepsis.