Antiplatelet therapy after coronary artery bypass surgery: the results from the randomized DACAB trial

We read with great interest the scientific work by Zhu and coworkers, which reports the 5-year results of the Different Antiplatelet Therapy Strategy After Coronary Artery Bypass Grafting (DACAB) randomized trial (1). The investigators have randomized 500 elective coronary artery bypass grafting (CABG) patients enrolled between July 2014 and November 2015 from six centers in China. One hundred and sixty-eight patients received dual antiplatelet therapy (DAPT) consisting of 90 mg of ticagrelor twice daily plus aspirin 100 mg once daily, 166 patients ticagrelor monotherapy 90 mg twice daily, and 166 patients aspirin monotherapy 100 mg once daily within 24 hours post-CABG. Primary outcomes were major adverse cardiovascular events (MACEs), including a composite of all-cause death, myocardial infarction, stroke, and coronary revascularization. The follow-up at 5 years was completed for 477 (95.4%) out of 500 patients. One hundred and forty-eight patients experienced MACE: of them 39 out of 159 in the DAPT group of patients (24.5%), 54 out of 157 in the ticagrelor group (34.4%), and 55 out of 161 in the aspirin group (34.2%). The risk of MACE at 5 years was significantly lower with the use of DAPT in comparison with aspirin therapy alone [22.6% vs. 29.9%; hazard ratio (HR) 0.65,95% confidence interval (CI): 0.43–0.99; P<0.05] and with ticagrelor therapy alone (22.6% vs. 32.9%; HR 0.66, 95% CI: 0.44–1.00; P=0.05). These results were consistent in all the statistical analyses performed.