Abstract 15446: Clinical Outcomes and Resource Utilization in Acute Coronary Syndrome Patients Receiving P2Y12 Inhibitors and Undergoing Early Coronary Artery Bypass Graft Surgery
Background: Antiplatelet loading with P2Y12 inhibitors in acute coronary syndrome (ACS) patients is common. Approximately 10-15% of ACS patients undergo coronary artery bypass graft (CABG) surgery. Consensus guidelines recommend P2Y12 inhibitors be discontinued 5 to 7 days before CABG. Data on clinical and cost implications of pre-operative P2Y12 inhibitor use in CABG surgery patients in the setting of ACS is limited in clinical practice. We assessed the impact of P2Y12 inhibitor use ≤5 days before CABG on clinical outcomes and resource utilization.
Methods: Using a shared electronic medical record we reviewed all non-emergent CABG +/- valve surgery cases presenting as ACS at three high volume centers from July 1, 2011 to May 7, 2013. Intra- and post-operative any blood product, red blood cell, plasma and platelet use, complications, intensive care unit (ICU) duration, length of stay and total variable costs were compared in patients with and without P2Y12 inhibitor use ≤5 days before surgery.
Results: Among 540 surgical cases, 121 (22.4%) had P2Y12 inhibitor use ≤5 days before surgery and 419 (77.6%) did not. Patients with P2Y12 inhibitor use had significantly greater intra-operative any blood product, red blood cell and platelet use, post-operative any blood product, red blood cell, plasma and platelet use, ICU duration, length of stay and total variable costs (p<0.05 for all) with a trend towards greater re-operative bleeding complications (p=0.059). In-hospital mortality was numerically lower, but did not reach significance due to lack of events (Figure).
Conclusions: Pre-operative P2Y12 inhibitor use ≤5 days before early CABG in the setting of ACS is associated with greater intra- and post-operative blood product use, ICU duration, length of stay and total variable costs. These results provide further support for health care providers to postpone CABG surgery until P2Y12 inhibitors have been discontinued for 5 days in ACS patients.
- © 2013 by American Heart Association, Inc.