Effect of Ticagrelor Versus Clopidogrel After Off‐Pump Coronary Artery Bypass Grafting on Postoperative Atrial Fibrillation: A Cohort Study
Background This study aimed to explore the effect of a P2Y12 inhibitor regimen on the occurrence of postoperative atrial fibrillation (POAF) after off‐pump coronary artery bypass graft surgery in carriers with the cytochrome P450 family 2 subfamily C member19 loss‐of‐function allele. Methods and Res...
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Wiley
2024-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.035424 |
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| author | Qin Jiang Keli Huang Lixue Yin Hong Kong Zhenglin Yang Shengshou Hu |
| author_facet | Qin Jiang Keli Huang Lixue Yin Hong Kong Zhenglin Yang Shengshou Hu |
| author_sort | Qin Jiang |
| collection | DOAJ |
| description | Background This study aimed to explore the effect of a P2Y12 inhibitor regimen on the occurrence of postoperative atrial fibrillation (POAF) after off‐pump coronary artery bypass graft surgery in carriers with the cytochrome P450 family 2 subfamily C member19 loss‐of‐function allele. Methods and Results From May 2019 to November 2023, patients containing the cytochrome P450 family 2 subfamily C member19*2 or *3 allele undergoing elective first‐time off‐pump coronary artery bypass graft surgery including aspirin 100 mg/d and ticagrelor 180 mg/d (AT group; n=95) versus clopidogrel 75 mg/d (aspirin and clopidogrel group; n=95) were prospectively followed. The primary end point was the cumulative incidence of POAF in a week. The secondary end points were POAF burden, platelet aggregability, systemic immune‐inflammation index and heart rate variability. The incidence of POAF was 21.1% in the AT group versus 41.1% in the aspirin and clopidogrel group (hazard ratio, 0.46 [95% CI, 0.27–0.76]; P=0.003). POAF burden, ADP‐induced platelet aggregation and systemic immune‐inflammation index was notably lower in the AT group than the aspirin and clopidogrel group. Heart rate variability data showed an increase in both high‐frequency and SD of normal‐to‐normal RR intervals in the AT group with a decreased low‐frequency/high‐frequency ratio, suggesting that the sympathetic/parasympathetic activation was balanced. Conclusions In patients carrying the cytochrome P450 family 2 subfamily C member19 loss‐of‐function allele, an AT regimen after off‐pump coronary artery bypass grafting was associated with a lower incidence of POAF, paralleled by lower atrial fibrillation burden, ADP‐induced platelet aggregation, lower systemic immune‐inflammation index reaction, and a balanced automatic nerve system compared with an aspirin and clopidogrel regimen. Inhibiting the systemic immune‐inflammation response and sustaining automatic nerve balance may underlie the therapeutic effect of POAF by a potent antiplatelet combination. |
| format | Article |
| id | doaj-art-4aa5a7b12e6e436cbe7d23c124fd3634 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-08-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-4aa5a7b12e6e436cbe7d23c124fd36342025-08-20T02:07:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-08-01131610.1161/JAHA.124.035424Effect of Ticagrelor Versus Clopidogrel After Off‐Pump Coronary Artery Bypass Grafting on Postoperative Atrial Fibrillation: A Cohort StudyQin Jiang0Keli Huang1Lixue Yin2Hong Kong3Zhenglin Yang4Shengshou Hu5Department of Cardiac Surgery, Sichuan Provincial People’s Hospital Affiliated Hospital of University of Electronic Science and Technology Chengdu ChinaDepartment of Cardiac Surgery, Sichuan Provincial People’s Hospital Affiliated Hospital of University of Electronic Science and Technology Chengdu ChinaUltrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province Chengdu ChinaDepartment of Cardiology, Sichuan Provincial People’s Hospital Affiliated Hospital of University of Electronic Science and Technology Chengdu ChinaThe Key Laboratory for Human Disease Gene Study of Sichuan Province and the Department of Laboratory Medicine University of Electronic Science and Technology of China Chengdu ChinaDepartment of Cardiac Surgery, Fuwai Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing ChinaBackground This study aimed to explore the effect of a P2Y12 inhibitor regimen on the occurrence of postoperative atrial fibrillation (POAF) after off‐pump coronary artery bypass graft surgery in carriers with the cytochrome P450 family 2 subfamily C member19 loss‐of‐function allele. Methods and Results From May 2019 to November 2023, patients containing the cytochrome P450 family 2 subfamily C member19*2 or *3 allele undergoing elective first‐time off‐pump coronary artery bypass graft surgery including aspirin 100 mg/d and ticagrelor 180 mg/d (AT group; n=95) versus clopidogrel 75 mg/d (aspirin and clopidogrel group; n=95) were prospectively followed. The primary end point was the cumulative incidence of POAF in a week. The secondary end points were POAF burden, platelet aggregability, systemic immune‐inflammation index and heart rate variability. The incidence of POAF was 21.1% in the AT group versus 41.1% in the aspirin and clopidogrel group (hazard ratio, 0.46 [95% CI, 0.27–0.76]; P=0.003). POAF burden, ADP‐induced platelet aggregation and systemic immune‐inflammation index was notably lower in the AT group than the aspirin and clopidogrel group. Heart rate variability data showed an increase in both high‐frequency and SD of normal‐to‐normal RR intervals in the AT group with a decreased low‐frequency/high‐frequency ratio, suggesting that the sympathetic/parasympathetic activation was balanced. Conclusions In patients carrying the cytochrome P450 family 2 subfamily C member19 loss‐of‐function allele, an AT regimen after off‐pump coronary artery bypass grafting was associated with a lower incidence of POAF, paralleled by lower atrial fibrillation burden, ADP‐induced platelet aggregation, lower systemic immune‐inflammation index reaction, and a balanced automatic nerve system compared with an aspirin and clopidogrel regimen. Inhibiting the systemic immune‐inflammation response and sustaining automatic nerve balance may underlie the therapeutic effect of POAF by a potent antiplatelet combination.https://www.ahajournals.org/doi/10.1161/JAHA.124.035424coronary bypass surgeryheart rate variabilityP2Y12 inhibitorpostoperative atrial fibrillationsystemic immune‐inflammation index |
| spellingShingle | Qin Jiang Keli Huang Lixue Yin Hong Kong Zhenglin Yang Shengshou Hu Effect of Ticagrelor Versus Clopidogrel After Off‐Pump Coronary Artery Bypass Grafting on Postoperative Atrial Fibrillation: A Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease coronary bypass surgery heart rate variability P2Y12 inhibitor postoperative atrial fibrillation systemic immune‐inflammation index |
| title | Effect of Ticagrelor Versus Clopidogrel After Off‐Pump Coronary Artery Bypass Grafting on Postoperative Atrial Fibrillation: A Cohort Study |
| title_full | Effect of Ticagrelor Versus Clopidogrel After Off‐Pump Coronary Artery Bypass Grafting on Postoperative Atrial Fibrillation: A Cohort Study |
| title_fullStr | Effect of Ticagrelor Versus Clopidogrel After Off‐Pump Coronary Artery Bypass Grafting on Postoperative Atrial Fibrillation: A Cohort Study |
| title_full_unstemmed | Effect of Ticagrelor Versus Clopidogrel After Off‐Pump Coronary Artery Bypass Grafting on Postoperative Atrial Fibrillation: A Cohort Study |
| title_short | Effect of Ticagrelor Versus Clopidogrel After Off‐Pump Coronary Artery Bypass Grafting on Postoperative Atrial Fibrillation: A Cohort Study |
| title_sort | effect of ticagrelor versus clopidogrel after off pump coronary artery bypass grafting on postoperative atrial fibrillation a cohort study |
| topic | coronary bypass surgery heart rate variability P2Y12 inhibitor postoperative atrial fibrillation systemic immune‐inflammation index |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.035424 |
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