Early vs Delayed Bypass Surgery in Patients With Acute Coronary Syndrome Receiving Ticagrelor: The RAPID CABG...

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.