Effect Of Different Antiplatelet Therapy Strategies On Patency Rate Of Saphenous Vein Graft Early After OPCAB And Predictor Analysis

Objective Saphenous vein graft(SVG)is a common graft used for coronary artery bypass grafting(CABG).Antiplatelet therapy is regarded as the most effective treatment to improve the patency of SVG.DACAB study is a multicenter randomized controlled trial designed to evaluate the effect of ticagrelor on the prevention of post-CABG vein graft failure(VGF).This study was a subgroup analysis of DACAB study,focusing on off-pump coronary artery bypass grafting(OPCAB),to explore the effect of different antiplatelet therapy strategies on the early patency rate of SVG,and to analyze the predictors of VGF.Methods A total of 233 patients and 700 SVGs were included in this study with 700 SVG.According to the randomization of DACAB study,patients were divided into aspirin monotherapy(100mg,Qd)cohort(Cohort A,n=77)and double antiplatelet therapy with aspirin(100mg,Qd)and ticagrelor(90mg,Bid)cohort(Cohort A+T,n=77)and ticagrelor(90mg,Bid)monotherapy cohort(Cohort T,n=79),who were postoperatively treated with corresponding antiplatelet therapy.Each patient underwent coronary artery computed tomography angiography during hospitalization and SVGs were evaluated according to Fitz Gibbon classification.The predictors of VGF(Fitz Gibbon Grade B/O)were screened by univariate and multinomial Logistic regression analysis.Results The Fitz Gibbon Grade A patency rate of SVG at 8.29±4.05 days after OPCAB was 94.1%.Preoperative and perioperative data were similar in three cohorts.The early patency rate of SVG of Cohort A+T was significantly higher than that of Cohort A(96.5% vs 90.7%,p=0.011).At patient level,when a patient with at least one VGF was regarded as an event,preoperative thrombocythemia(OR=9.848,p=0.008),quantity of perioperatively transfused red blood cell(RBC)(OR=1.544,p=0.006)and creatinine clearance rate(CCr)(OR=1.037,p<0.001)were the independent risk factors of patients with early VGF.The use of the LIMA graft was an independent protective factor against early VGF(OR = 0.348,p=0.037).At the SVG level,when VGF was regarded as an event,preoperative thrombocythemia(OR=17.641,p<0.001),CCr(OR=1.033,p<0.001),quantity of perioperatively transfused RBC(OR=1.547,p=0.001)and endarterectomy(OR=5.902,p=0.049)were the independent risk factors of early VGF.Postoperative antiplatelet therapy strategy(Cohort A+T vs Cohort A,OR=0.373,p=0.037),recipient vessel diameter(OR=0.047,p=0.002),graft run-off(OR=0.952,p<0.001)and coronary artery anastomotic technique(side-to-side vs end-to-side anastomosis,OR=0.275,p<0.001)were the independent protective factors against early VGF.Conclusions The early Fitz Gibbon Grade A patency rate of SVG after OPCAB was satisfactory.DAPT with aspirin plus ticagrelor significantly improved the early patency of SVG and reduced early VGF without increased bleeding risk.At patient level,preoperative thrombocythemia,increased quantity of perioperatively transfused RBC and CCr were the independent risk predictors of early VGF,and the use of LIMA graft was an independent protective predictor against early VGF.At SVG level,preoperative thrombocythemia,perioperative erythrocyte transfusion,CCr and endarterectomy were independent risk predictors of early VGF,and postoperative antiplatelet therapy strategy(aspirin plus ticagrelor vs single aspirin),recipient vessel diameter,graft run-off and coronary anastomotic technique(side-to-side vs end-to-side anastomosis)were independent protective predictors against early VGF.