Sex differences among patients receiving ticagrelor monotherapy or aspirin after coronary bypass surgery: A prespecified subgroup analysis of the TiCAB trial

There is limited evidence on the association of sex with outcomes among patients undergoing coronary bypass surgery (CABG) and treated with ticagrelor monotherapy or aspirin. This was a pre-specified sub-analysis of TiCAB, an investigator-initiated placebo-controlled randomized trial. Primary effica...

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Published in:International journal of cardiology 2023-01, Vol.370, p.129-135
Main Authors: Sandner, Sigrid, Kastrati, Adnan, Niessner, Alexander, Böning, Andreas, Zeymer, Uwe, Conradi, Lenard, Danner, Bernhard, Zimpfer, Daniel, Färber, Gloria, Manville, Emely, Schunkert, Heribert, von Scheidt, Moritz, Grothusen, Christina, Cremer, Jochen, Attmann, Tim, Friedrich, Ivar, Oberhoffer, Martin, Knosalla, Christoph, Walther, Thomas, Wimmer-Greinecker, Gerhard, Siepe, Matthias, Grubitzsch, Herko, Joost, Alexander, Schaefer, Andreas, Misfeld, Martin, Laufer, Günther, Wiedemann, Dominik, Englberger, Lars, Hambrecht, Rainer
Format: Article
Language:English
Subjects:
Antiplatelet monotherapy
Aspirin
Aspirin - adverse effects
Coronary bypass surgery
Drug Therapy, Combination
Female
Hemorrhage - chemically induced
Humans
Male
Percutaneous Coronary Intervention - adverse effects
Platelet Aggregation Inhibitors - adverse effects
Sex
Sex Characteristics
Ticagrelor
Ticagrelor - therapeutic use
Treatment Outcome
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Summary:There is limited evidence on the association of sex with outcomes among patients undergoing coronary bypass surgery (CABG) and treated with ticagrelor monotherapy or aspirin. This was a pre-specified sub-analysis of TiCAB, an investigator-initiated placebo-controlled randomized trial. Primary efficacy endpoint was the composite of cardiovascular death, myocardial infarction, stroke, or repeat revascularization 1 year after CABG. Safety endpoint was BARC type 2, 3 or 5 bleeding. A total of 280 (15.0%) women and 1579 (85.0%) men were included. Compared with men, women were older (66.1 ± 10.2 vs. 70.1 ± 9.3 years) with more acute presentation (17.0% vs 21.1%). The incidence of the primary endpoint was similar between women and men (9.2% vs. 8.9%, HR 1.08, 95%CI 0.71–1.66, P = 0.71). Cardiovascular death occurred more often in women (2.9% vs 1.0%, adjusted HR 2.87, 95%CI 1.23–6.70, P = 0.02). The incidence of bleeding was similar between the sexes (2.2% vs. 2.5%, HR 0.91, 95% CI 0.51–1.65, P = 0.77). Ticagrelor vs aspirin was associated with a similar risk of the primary endpoint in women (10.6% vs. 7.9%, HR 1.39, 95%CI 0.63–3.05, P = 0.42) and men (9.5% vs. 8.2%, HR 1.15, 95%CI 0.82–1.62, P = 0.41;pinteraction = 0.69), and a similar risk of bleeding in women (2.9% vs. 1.4%, HR 2.09, 95%CI 0.38–11.41, P = 0.40) and men (2.2% vs. 2.8%, HR 0.80, 95%CI 0.42–1.52, P = 0.49;pinteraction = 0.35). Among women and men undergoing CABG, ticagrelor monotherapy was associated with a similar risk of the primary efficacy endpoint and bleeding compared with aspirin. The risk of cardiovascular death was increased in women irrespective of antiplatelet therapy. •There are significant baseline risk differences between women and men undergoing CABG.•Ticagrelor and aspirin were associated with a similar risk of CV death, MI, stroke, or revascularization in women and men.•Ticagrelor and aspirin were associated with a similar risk of clinically important bleeding events in women and men.•Women had a higher risk of CV death 30 days and 1 year after CABG irrespective of type of antiplatelet therapy.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2022.10.166