Suspending ticagrelor a couple of days before surgery was non-inferior to waiting 5-6 days in terms of bleeding in patients with acute coronary syndrome (ACS) requiring myocardial revascularization surgery. Patients who waited longer had more ischemic events and longer hospitalizations.
Current American guidelines recommend waiting at least 5 days before operating on patients with ACS who received ticagrelor when admitted, while European guidelines recommend only 3 days.
RAPID CABG included 143 patients with ACS (93% of them with multivessel disease) for whom surgery was considered the most adequate strategy. Patients were randomized to undergo surgery between 2-3 days vs. 5-7 days after interrupting ticagrelor.
Mean time-to-surgery was 3 and 6 days in the early and delay arms, respectively.
The primary endpoint, severe bleeding (BARC 3/4), was similar between groups (4.6% vs. 5.2%, p = 0.0253), meaning the early strategy reached non-inferiority.
No patient in the early arm presented recurrent angina during the 2 days of waiting. Something very different occurred in the arm with the longer wait. There were 8.7% of patients with ischemic events, including an infarction.
Read also: AHA 2021 | AVATAR: Early Intervention in Asymptomatic Aortic Stenosis.
Hospitalization length was also shorter in the early surgery arm (9 vs. 12 days).
Original Title: A randomized study of early vs. delayed coronary artery bypass surgery among patients with acute coronary syndromes treated with ticagrelor: the RAPID CABG study.
Reference: So DYF et al. Presentado durante las sesiones científicas del AHA 2021.
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