The impact of ticagrelor therapy on CABG-related bleeding in patients with STEMI managed with pPCI and following on-pump CABG.

Autor: Durmaz E; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey. durmazeser@hotmail.com., Ikitimur B; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., Arapi B; Department of Cardiovascular Surgery, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey., Tel Ustunisik C; Department of Cardiology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey., Soysal AU; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., İncesu G; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., Gulfidan A; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., Yalman H; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., Cidem S; Department of Cardiovascular Surgery, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey., Tokdil H; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., Raimoglu U; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., Raimoglou D; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., Akman Z; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey., Atici A; Department of Cardiology, Istanbul Medeniyet University, Goztepe Research and Training Hospital, Istanbul, Turkey., Karadag B; Department of Cardiology, Cerrahpasa School of Medicine, Cerrahpasa/Fatih, Istanbul University-Cerrahpasa, Kocamustafapasa Street, 34098, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: Heart and vessels [Heart Vessels] 2024 Jul 20. Date of Electronic Publication: 2024 Jul 20.
DOI: 10.1007/s00380-024-02434-1
Abstrakt: Patients on double antiplatelet treatment who need early in-hospital coronary artery bypass grafting (CABG) are at high risk of major bleeding. In this study, we aimed to investigate the impact of ticagrelor preloading on CABG related bleeding in patients with ST-segment elevation myocardial infarction (STEMI) initially managed with primary percutaneous coronary intervention (pPCI). Patients with the diagnosis of STEMI who were managed with pPCI and underwent subsequent early (4-7 days following pPCI) or delayed (> 7 days following pPCI) on-pump CABG surgery were included. All study patients were preloaded with ticagrelor 180 mg prior to pPCI procedure. Patients' demographics, clinical variables, and short-term cardiovascular outcomes were recorded. This is a retrospective study which included 98 patients. Fifty-four (54%) patients underwent early and 44 (45%) patients underwent delayed CABG surgery. CABG-related bleeding occurred in 22 (22.4%) patients. There was no significant difference with respect to total ticagrelor dose and timing of the surgery between patients with or without CABG-related bleeding (p: 0.165 and p: 0.142). Multivariate analyses demonstrated that only preoperative hemoglobin level < 10.9 and use of mechanical cardiac support devices were independent predictors of CABG-related bleeding [OR: 3719, p: 0.009 and OR: 11,698, p: 0.004, respectively].There were three deaths within the 30 days of surgery, all occurring in patients with CABG-related bleeding. However, CABG-related bleeding was not associated with long-term cardiovascular events during the follow-up. Our results indicated that discontinuation of ticagrelor therapy 3 days prior to surgery is sufficient to avoid CABG-related bleeding. Moreover, early CABG following STEMI does not increase the risk of long-term cardiovascular events.
(© 2024. Springer Nature Japan KK, part of Springer Nature.)
Databáze: MEDLINE
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