Related Experiment Video
Updated: May 12, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Early vs Delayed Bypass Surgery in Patients With Acute Coronary Syndrome Receiving Ticagrelor: The RAPID CABG
Derek Y F So1, George A Wells2, Marie Lordkipanidzé3,4
1Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Insights
Early coronary artery bypass graft (CABG) surgery within 2-3 days of stopping ticagrelor is as safe as waiting 5-7 days regarding perioperative bleeding. This approach may reduce hospital stays for acute coronary syndrome patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Pharmacology
Background:
- Perioperative bleeding is a significant risk for patients on ticagrelor requiring coronary artery bypass graft (CABG) surgery.
- Optimizing the timing of CABG after ticagrelor cessation is crucial for patient safety and outcomes.
Purpose of the Study:
- To determine if early CABG (2-3 days post-ticagrelor cessation) is noninferior to delayed CABG (5-7 days) in terms of perioperative bleeding.
- To evaluate other bleeding, ischemic, and length-of-stay outcomes for superiority.
Main Methods:
- A noninferiority, open-label randomized trial (RAPID CABG) involving patients with acute coronary syndromes (ACS) who received ticagrelor and needed CABG.
- Patients were randomized to early (2-3 days) or delayed (5-7 days) CABG after ticagrelor cessation.
- Primary outcome: noninferiority of Class 3 or 4 Universal Definition of Perioperative Bleeding (UDPB); secondary outcomes assessed for superiority.
Main Results:
- In a per-protocol analysis, severe/massive UDPB occurred in 4.6% of the early group vs. 5.2% of the delayed group (noninferiority met).
- Median chest tube drainage was similar between groups, meeting noninferiority criteria.
- The early CABG group experienced significantly shorter hospital stays (median 9 days vs. 12 days).
Conclusions:
- Early CABG surgery (2-3 days after ticagrelor cessation) is noninferior to delayed surgery regarding perioperative bleeding.
- This strategy supports reducing the waiting time between ticagrelor cessation and CABG, potentially decreasing hospital length of stay.
Importance:
Perioperative bleeding is a major concern in patients receiving ticagrelor for acute coronary syndromes (ACS) when coronary artery bypass graft (CABG) surgery is required.
Objective:
To evaluate whether early CABG surgery at 2 to 3 days after ticagrelor cessation is noninferior to waiting 5 to 7 days.
Design, Setting, And Participants:
RAPID CABG was a noninferiority, open-label randomized trial with 6 months of follow-up. Participants were patients with ACS who had received ticagrelor and required CABG. Patients were enrolled in tertiary centers in Canada between January 2016 and March 2021. Data were analyzed from March 2021 to December 2023.
Intervention:
Early or delayed CABG.
Main Outcomes And Measures:
The primary outcome was based on noninferiority comparison of class 3 or 4 universal definition of perioperative bleeding (UDPB). Noninferiority was prespecified as 8% between groups. Twelve-hour chest tube drainage was reported as a noninferiority comparison. Other bleeding, ischemic, and length-of-stay outcomes were assessed for superiority.
Results:
Among 143 randomized patients, the median (IQR) age was 65 (58-72) years; there were 117 male patients (82%) and 26 female (18%). Of these, 123 patients (86.0%) underwent surgery in the allocated time frame (per protocol). The median (IQR) time to surgery was 3 (2-3) days in the early group and 6 (5-7) days in the delayed group (P < .001). In a per-protocol analysis, severe or massive UDPB occurred in 3 of 65 early-group patients (4.6%) and 3 of 58 patients (5.2%) in the delayed group (between-group difference, -0.6%; 95% CI, -8.3% to 7.1%; P = .03 for noninferiority). Median (IQR) chest tube drainage was 470 (330-650) mL vs 495 (380-610) mL (between-group difference -25 mL; 95% CI, -111.25 to 35; P = .01 for noninferiority). Median (IQR) hospital stay was 9 (7-13) days and 12 (10-15) days for the early and delayed groups (P < .001).
Conclusion And Relevance:
This study found that an early surgical strategy, 2 to 3 days after ticagrelor cessation, was noninferior in incurring perioperative bleeding. The data support a reduction in the delay between ticagrelor cessation and CABG surgery and may decrease hospital length of stay.
Trial Registration:
ClinicalTrials.gov Identifier: NCT02668562.
More Related Videos
07:02Operating Transverse Aortic Constriction with Absorbable Suture to Obtain Transient Myocardial Hypertrophy
Published on: September 9, 2020
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care