Ticagrelor-based De-escalation of Dual Antiplatelet Therapy After Coronary Artery Bypass Grafting

After informed consent, at least 10 centers and 2,300 eligible admissions will be recruited. Eligible patients would be randomized (1:1) in double-blind manner (patients and treating physicians) to dual antiplatelet therapy (DAPT) group (ticagrelor 90mg bid and aspirin 100 mg qd for 12 month) and de-escalated DAPT (De-DAPT) group (90mg bid and aspirin 100 mg qd for first 3 months, and then aspirin 100 mg qd and placebo for 9 months).

Inclusion criteria

• Patients 18-80 of age. 2. Patients undergo planned CABG for the first time with ≥1 SVGs 3. Patients with written informed consent. Exclusion criteria

• Concomitant valve (excluding aortic bioprosthesis), aorta, or rhythm surgery during the same session.
• Patients undergo emergency CABG.
• Patients with single coronary artery disease.
• Patients with cardiogenic shock and hemodynamic instability.
• Patients with sick sinus syndrome, 2nd or 3rd atrioventricular block.
• Patients with contraindications for coronary computed tomography angiography or coronary angiography (eg. contrast allergy).
• Use of other antiplatelet drugs than aspirin or ticagrelor (clopidogrel, prasugrel, etc) and unable to discontinue this medication after CABG, in the treating physician's or the investigator's opinion.
• Patients who take oral anticoagulants before CABG and have to use anticoagulants after surgery.
• Contraindication for the use of ticagrelor or aspirin (ie. history of bleeding diathesis within 3 months prior presentation, severe gastrointestinal bleeding within 1year prior presentation, peptic ulcer without gastrointestinal bleeding in past 3 years or history of intracranial hemorrhage, allergy, severe gastrointestinal reaction caused by aspirin).
• Placement of a drug-eluting stent in a coronary or cerebral artery within 6 months of CABG or placement of a bare-metal stent in a coronary or cerebral artery within 1 month of CABG
• Thrombocytopenia before CABG (< 100 x 109/L).
• patients with severe renal function impairment requiring dialysis or active liver disease, including patients with unexplained persistent elevated transaminase or any transaminase more than 3 times the normal limit.
• Use of strong inhibitors of CYP3A4
• Patients who have to use methotrexate and ibuprofen.
• Patients with active malignant tumors with increase in bleeding risk in the investigator's opinion
• Pregnant patients, patients who have given birth within the past 90 days, or who are breastfeeding.
• Premenopausal women who do not take adequate contraception. Adequate contraception refers to the adoption of at least two reliable methods of contraception, one of which must be a barrier method of contraception.
• CABG volume of the surgeon less than 50.