DAPT After CABG – TACSI & TOP-CABG Trials
DAPT After CABG – TACSI & TOP-CABG Trials
Source: Medscape, ESC Congress 2025 – September 10, 2025
1. Background
• Current guidelines: 12 months of DAPT after CABG in ACS patients.
• Evidence mainly extrapolated from PCI and non-CABG trials.
2. TACSI Trial (Nordic countries, 2,201 ACS patients)
• Compared: Aspirin + Ticagrelor (12 months) vs Aspirin alone.
• Primary outcome (death, MI, stroke, repeat revascularization): 4.8% vs 4.6% → no difference.
• Major bleeding: higher with DAPT (4.9% vs 2.0%; HR 2.50).
• Net adverse events (ischemia + bleeding): worse with DAPT (9.1% vs 6.4%).
• Conclusion: No added benefit, more bleeding → aspirin should remain standard after CABG.
3. TOP-CABG Trial (China, 2,300 elective CABG patients)
• Compared: 3 months DAPT → aspirin vs 12 months DAPT.
• Vein graft occlusion at 1 year: similar (10.8% vs 11.2%).
• Clinically relevant bleeding: lower with 3 months (8.3% vs 13.2%; P<0.001).
• Conclusion: 3-month DAPT safer; balances graft protection with bleeding risk.
4. Expert Perspectives
• TACSI: “No clear role for routine DAPT after CABG; aspirin-only is standard.”
• TOP-CABG: Shorter (3-month) DAPT appears as effective as 12 months, with less bleeding.
• Need for trials with aspirin-only arms and long-term follow-up.
5. Take-home Message
• 12-month DAPT after CABG is not supported by strong evidence.
• Aspirin alone is sufficient for most patients.
• 3-month DAPT may be considered in selected patients at low bleeding risk.
• Future guidelines likely to revisit current recommendations.
Clinical implication: CABG patients differ biologically from PCI patients — no stent left behind, so prolonged DAPT may not be necessary.
