AHA 2021 | RAPID CABG: Safety of Early Surgical Intervention in Acute Coronary Syndrome

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.

AHA 2021 | RAPID CABG: seguridad de ir al quirófano precozmente en un síndrome coronario agudo

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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