近日，瑞典萨尔格伦斯卡大学医院Anders Jeppsson团队研究了替格瑞洛联合阿司匹林或单独阿司匹林治疗急性冠脉综合征的疗效与安全性。相关论文发表在2025年9月2日出版的《新英格兰医学杂志》上。

急性冠状动脉综合征患者接受冠状动脉搭桥术（CABG）后抗血小板治疗获益。与阿司匹林单独使用相比，替格瑞洛与阿司匹林联合使用是否能进一步降低心血管不良结局的风险尚不清楚。

在这项开放标签、注册为基础的临床试验中，研究组在22个北欧心胸外科中心进行了研究，以1:1的比例随机分配患者，在急性冠状动脉综合征冠脉搭桥后1年内接受替格瑞洛加阿司匹林或阿司匹林单独治疗。主要结局是死亡、心肌梗死、卒中或重复血运重建术的综合结果，在1年进行评估。一个关键的次要结局是净不良临床事件，定义为主要结局事件或大出血。

共有2201例患者被随机分配到替格瑞洛联合阿司匹林（1104例）或阿司匹林单独（1097例）治疗组。患者平均年龄66岁，女性14.4%。替格瑞洛加阿司匹林组有53例（4.8%）患者发生主要结局事件，单独阿司匹林组有50例（4.6%）患者发生主要结局事件（风险比1.06；95%可信区间0.72 ~ 1.56；P=0.77）。替格瑞洛联合阿司匹林组净不良临床事件发生率为9.1%，阿司匹林单独组为6.4%（风险比为1.45；95% CI为1.07 ~ 1.97）。替格瑞洛加阿司匹林组的患者大出血发生率为4.9%，单独使用阿司匹林组的患者大出血发生率为2.0%（风险比2.50;95% CI, 1.52 ~ 4.11）。

研究结果表明，在因急性冠状动脉综合征而行冠脉搭桥的患者中，替格瑞洛联合阿司匹林在1年内的死亡、心肌梗死、卒中或重复冠状动脉重建术的发生率并不低于单独使用阿司匹林。

附：英文原文

Title: Ticagrelor and Aspirin or Aspirin Alone after Coronary Surgery for Acute Coronary Syndrome

Author: Anders Jeppsson, Stefan James, Christian H. Moller, Carl Johan Malm, Magnus Dalén, Farkas Vanky, Ivy Susanne Modrau, Karl Andersen, Vesa Anttila, Gennady V. Atroshchenko, Mikael Barbu, Mats Dreifaldt, Ali Imad El-Akkawi, rjan Friberg, Tomas Gudbjartsson, Jarmo Gunn, Rune Haaverstad, Jari Halonen, Emma C. Hansson, Jonas Holm, Annastiina Husso, Tatu Juvonen, yvind Jakobsen, Lena Jideus, Emilia Johannesson, Anna Jonsson Holmdahl, Kristjan Jonsson, Solveig Moss Kolseth, Lytfi Krasniqi, Tuomas Mkel, Ari Mennander, Lars-Erik Mohagen Krogstad, Sulman Rafiq, Peter Raivio, Lars Riber, Aminah Tahir, Carl Thorsen, Theis Tnnessen, Alexander Wahba, Igor Zindovic, Aldina Pivodic, Susanne J. Nielsen, David Erlinge, Joakim Alfredsson, Ulrik Sartipy

Issue&Volume: 2025-09-01

Abstract:

Background

Patients benefit from antiplatelet therapy after coronary-artery bypass grafting (CABG) for an acute coronary syndrome. Whether the addition of ticagrelor to aspirin, as compared with aspirin alone, further reduces the risk of adverse cardiovascular outcomes is unclear.

Methods

In this open-label, registry-based, clinical trial conducted at 22 Nordic cardiothoracic surgery centers, we randomly assigned patients in a 1:1 ratio to receive either ticagrelor plus aspirin or aspirin alone for 1 year after CABG for an acute coronary syndrome. The primary outcome was a composite of death, myocardial infarction, stroke, or repeat revascularization, evaluated at 1 year. A key secondary outcome was net adverse clinical events, defined as a primary-outcome event or major bleeding.

Results

A total of 2201 patients were randomly assigned to receive ticagrelor plus aspirin (1104 patients) or aspirin alone (1097 patients). The mean age of the patients was 66 years, and 14.4% were women. A primary-outcome event occurred in 53 patients (4.8%) in the ticagrelor-plus-aspirin group and 50 (4.6%) in the aspirin-alone group (hazard ratio, 1.06; 95% confidence interval [CI], 0.72 to 1.56; P=0.77). Net adverse clinical events occurred in 9.1% of patients in the ticagrelor-plus-aspirin group and 6.4% in the aspirin-alone group (hazard ratio, 1.45; 95% CI, 1.07 to 1.97). Major bleeding occurred in 4.9% of patients in the ticagrelor-plus-aspirin group and 2.0% in the aspirin-alone group (hazard ratio, 2.50; 95% CI, 1.52 to 4.11).

Conclusions

Among patients who underwent CABG for an acute coronary syndrome, ticagrelor plus aspirin did not result in a lower incidence of death, myocardial infarction, stroke, or repeat coronary revascularization than aspirin alone at 1 year.

DOI: NJ202509010000021

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2508026