A randomized, double-blind, placebo-controlled trial investigating the effect of Ticagrelor on saphenous vein graft patency in patients undergoing coronary artery bypass grafting surgery - rationale and design of the POPular CABG trial

Summary Rationale An estimated 15% of saphenous vein grafts (SVGs) occlude in the first year after coronary artery bypass grafting (CABG) despite aspirin therapy. Graft occlusion can result in symptoms, myocardial infarction (MI) and death. SVG occlusion is primarily caused by atherothrombosis, in which platelet activation plays a pivotal role. Evidence regarding the effect of stronger platelet inhibition on SVG patency after CABG is limited. Main objective of the POPular CABG trial is to determine whether dual antiplatelet therapy (DAPT) with aspirin plus ticagrelor improves SVG patency when compared to aspirin alone. Study The POPular CABG is a randomized, double-blind, placebo-controlled, multicenter trial, investigating the effect of adding ticagrelor to standard aspirin therapy on the rate of SVG occlusion. A total of 500 patients undergoing CABG with ≥1 SVG are randomized to ticagrelor or placebo. The primary endpoint is SVG occlusion rate, assessed with coronary computed tomography angiography (CCTA) at one year. Secondary endpoints are stenoses and occlusions in both SVGs and arterial grafts and SVG failure at one year, defined as a composite of SVG occlusion on CCTA or coronary angiography, SVG revascularization, MI in the territory supplied by a SVG or sudden death. Safety endpoints are bleeding events at 30 days and one year. Conclusion The POPular CABG trial investigates whether adding ticagrelor to standard aspirin after CABG reduces the rate of SVG occlusion at one year.