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Insight

Rafael Gomes Highlights Key ESC 2025 CABG Findings: Aspirin Monotherapy Still Best After Surgery

Rafael Gomes/LinkedIn

Sep 12, 2025, 05:33

Rafael Gomes Highlights Key ESC 2025 CABG Findings: Aspirin Monotherapy Still Best After Surgery

Rafael Gomes, Cardiologist at Real Hospital Português, posted on LinkedIn:

”European Society of Cardiology Congress 2025 – Hotline 10: CABG and beyond

NEWTON-CABG CardioLink-5 (Canada, multicenter RCT)
Evolocumab (PCSK9 inhibitor) did not improve saphenous vein graft (SVG) patency at 24 months after CABG. Despite a ~48% LDL-C reduction, SVG disease remained similar (21.7% vs 19.7%, p=0.44).
Takeaway: vein graft failure is likely more driven by thrombosis, remodeling, and inflammation than by LDL-C levels alone.
TACSI Trial (Nordic registry-based RCT)
In ACS patients undergoing CABG, 12 months of DAPT (aspirin + ticagrelor) was not superior to aspirin alone for preventing MACE (4.8% vs 4.6%). Major bleeding was more frequent with DAPT (4.9% vs 2.0%).
Takeaway: aspirin monotherapy remains the safest strategy post-CABG in ACS.
TOP-CABG (China, large trial)
Compared early intensive statin therapy vs standard initiation after CABG. Intensive early statin initiation showed modest improvement in lipid lowering, but no significant differences in major graft or clinical outcomes at 1 year.
Takeaway: timing of statin initiation may be less important than long-term adherence.
OPINION Trial – 1-year outcomes (China, multicenter RCT)
Compared off-pump vs on-pump CABG. At 1 year, no significant differences in death, MI, stroke, or repeat revascularization between strategies.
Takeaway: both surgical techniques remain acceptable, with outcomes driven more by surgical expertise and patient selection.
Key message: In CABG patients, simpler strategies often prevail:
• PCSK9 inhibition did not rescue SVG patency (NEWTON-CABG).
• DAPT offered no net benefit over aspirin (TACSI).
• Early statin timing and surgical technique (TOP-CABG & OPINION) did not alter short-term outcomes significantly.

Ongoing follow-up will clarify whether longer-term differences emerge, but for now, evidence supports aspirin monotherapy, consistent statin therapy, and tailored surgical approach as the mainstays of post-CABG care.”

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Aspirin CABG Cardiology Coronary artery bypass grafting ESC 2025 European Society of Cardiology European Society of Cardiology Congress 2025 Evolocumab Health Hematology Hemostasis Hemostasis Today Medicine NEWTON-CABG CardioLink-5 OPINION Trial PCSK9 inhibitor Rafael Gomes Real Hospital Português Saphenous Vein Graft SVG TACSI Trial thrombosis

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