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Rafael Gomes: CoCAP Study Challenges Prolonged DAPT After CABG

Rafael Gomes/LinkedIn

Sep 1, 2026, 14:18

Rafael Gomes: CoCAP Study Challenges Prolonged DAPT After CABG

Rafael Gomes, Cardiologist, Echocardiographer, Ergometrist at Real Hospital Português, shared a post on LinkedIn:

“ESC Munich 2026 | Does DAPT improve vein graft patency after CABG?

After CABG for acute coronary syndrome, dual antiplatelet therapy is commonly resumed when bleeding risk allows.

But does ticagrelor plus aspirin actually keep saphenous vein grafts more patent than aspirin alone?

The CoCAP study, presented by Associate Professor Jonas Holm at European Society of Cardiology Congress 2026, addressed this question.

CoCAP was a prespecified imaging substudy of the randomized TACSI trial.

382 patients
ACS patients undergoing CABG
Ticagrelor plus aspirin versus aspirin alone for 12 months
Coronary CT angiography performed around 20 months after surgery

The primary endpoint was vein graft patency with less than 50 percent stenosis.

Ticagrelor plus aspirin: 83.3 percent
Aspirin alone: 81.6 percent
Adjusted risk difference: 1.2 percent
p=0.70

There was also no significant difference in graft non-occlusion when analyzed per patient, per graft, or per graft segment.

No subgroup showed a clear benefit from DAPT.

What does this mean for clinical practice?

The key message is simple:

Ticagrelor-based DAPT did not improve vein graft patency compared with aspirin alone.

This does not mean that DAPT has no role after CABG for ACS.

In these patients, DAPT may still be indicated because of the acute coronary syndrome itself, aiming to reduce recurrent ischemic events.

What CoCAP challenges is the idea of using prolonged ticagrelor-based DAPT specifically to keep the vein graft open.

Another important finding is that vein graft failure remains frequent even with contemporary therapy, affecting roughly 15–20 percent of patients or grafts in recent studies.

This reinforces that improving long-term CABG outcomes will likely require more than intensified antiplatelet therapy: surgical technique, arterial grafting, lipid lowering and better understanding of vein graft failure remain essential.

Bottom line:

After CABG for ACS, treat the ACS appropriately — but do not assume that more antiplatelet therapy means better vein graft patency.”

Rafael Gomes: CoCAP Study Challenges Prolonged DAPT After CABG