Outcomes of Coronary Artery By-Pass Grafting Under Dual Antiplatelet Therapy in ST Elevated Myocardial Infarction

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Clinical Research

Background:

• Patients with recent myocardial infarction (MI) or percutaneous coronary interventions (PCI) face elevated ischemic and bleeding risks during coronary artery bypass grafting (CABG).
• Existing data on preoperative dual antiplatelet therapy (DAPT) in this high-risk group lacks definitive recommendations.

Purpose of the Study:

• To investigate the association between preoperative DAPT use and adverse outcomes, specifically in-hospital mortality and major bleeding.
• To analyze outcomes in ST-elevation myocardial infarction (STEMI) patients undergoing subsequent CABG surgery.

Main Methods:

• Retrospective analysis of 748 consecutive STEMI patients who underwent CABG.
• Patients were categorized based on DAPT use: continued until the day before CABG versus discontinued more than 5 days prior.
• Multivariate analysis was employed to identify predictors of in-hospital mortality and major bleeding.

Main Results:

• Preoperative DAPT was not significantly associated with increased in-hospital mortality (OR: 1.81, 95% CI: 0.89-3.68, P = 0.10).
• Preoperative DAPT did not correlate with higher rates of major bleeding (OR: 1.15, 95% CI: 0.63-2.08, P = 0.65).
• Glycoprotein (Gp) 2b/3a inhibitors, however, were independently linked to increased major bleeding. Age, shock, and ejection fraction (EF) <30% predicted mortality, while previous MI, Gp 2b/3a inhibitors, and EF <30% predicted bleeding.

Conclusions:

• Continuing DAPT before CABG in STEMI patients is not associated with elevated in-hospital mortality or major bleeding risk.
• Glycoprotein 2b/3a inhibitor use, advanced age, shock, and low ejection fraction are significant predictors of adverse outcomes in this patient cohort.