المؤلفون: Sandner, Sigrid¹ (AUTHOR) sigrid.sandner@meduniwien.ac.at, Kastrati, Adnan^2,3 (AUTHOR), Niessner, Alexander⁴ (AUTHOR), Böning, Andreas⁵ (AUTHOR), Zeymer, Uwe⁶ (AUTHOR), Conradi, Lenard⁷ (AUTHOR), Danner, Bernhard⁸ (AUTHOR), Zimpfer, Daniel⁹ (AUTHOR), Färber, Gloria¹⁰ (AUTHOR), Manville, Emely¹ (AUTHOR), Schunkert, Heribert^2,3 (AUTHOR), von Scheidt, Moritz^2,3 (AUTHOR)

المصدر: International Journal of Cardiology. Jan2023, Vol. 370, p129-135. 7p.

مصطلحات موضوعية: *CORONARY artery bypass, *DRUG-eluting stents, *ASPIRIN, *TICAGRELOR, *SUBGROUP analysis (Experimental design), CARDIOVASCULAR disease related mortality

مستخلص: There is limited evidence on the association of sex with outcomes among patients undergoing coronary bypass surgery (CABG) and treated with ticagrelor monotherapy or aspirin. This was a pre-specified sub-analysis of TiCAB, an investigator-initiated placebo-controlled randomized trial. Primary efficacy endpoint was the composite of cardiovascular death, myocardial infarction, stroke, or repeat revascularization 1 year after CABG. Safety endpoint was BARC type 2, 3 or 5 bleeding. A total of 280 (15.0%) women and 1579 (85.0%) men were included. Compared with men, women were older (66.1 ± 10.2 vs. 70.1 ± 9.3 years) with more acute presentation (17.0% vs 21.1%). The incidence of the primary endpoint was similar between women and men (9.2% vs. 8.9%, HR 1.08, 95%CI 0.71–1.66, P = 0.71). Cardiovascular death occurred more often in women (2.9% vs 1.0%, adjusted HR 2.87, 95%CI 1.23–6.70, P = 0.02). The incidence of bleeding was similar between the sexes (2.2% vs. 2.5%, HR 0.91, 95% CI 0.51–1.65, P = 0.77). Ticagrelor vs aspirin was associated with a similar risk of the primary endpoint in women (10.6% vs. 7.9%, HR 1.39, 95%CI 0.63–3.05, P = 0.42) and men (9.5% vs. 8.2%, HR 1.15, 95%CI 0.82–1.62, P = 0.41;p interaction = 0.69), and a similar risk of bleeding in women (2.9% vs. 1.4%, HR 2.09, 95%CI 0.38–11.41, P = 0.40) and men (2.2% vs. 2.8%, HR 0.80, 95%CI 0.42–1.52, P = 0.49;p interaction = 0.35). Among women and men undergoing CABG, ticagrelor monotherapy was associated with a similar risk of the primary efficacy endpoint and bleeding compared with aspirin. The risk of cardiovascular death was increased in women irrespective of antiplatelet therapy. • There are significant baseline risk differences between women and men undergoing CABG. • Ticagrelor and aspirin were associated with a similar risk of CV death, MI, stroke, or revascularization in women and men. • Ticagrelor and aspirin were associated with a similar risk of clinically important bleeding events in women and men. • Women had a higher risk of CV death 30 days and 1 year after CABG irrespective of type of antiplatelet therapy. [ABSTRACT FROM AUTHOR]

المؤلفون: Caliskan, Etem, Misfeld, Martin, Sandner, Sigrid, Böning, Andreas, Aramendi, Jose, Salzberg, Sacha P, Choi, Yeong-Hoon, Perrault, Louis P, Tekin, Ilker, Cuerpo, Gregorio P, Lopez-Menendez, Jose, Weltert, Luca P, Böhm, Johannes, Krane, Markus, González-Santos, José M, Tellez, Juan-Carlos, Holubec, Tomas, Ferrari, Enrico, Emmert, Maximilian Y, investigators, European DuraGraft Registry

المصدر: European Journal of Cardio-Thoracic Surgery; Oct2022, Vol. 62 Issue 4, p1-9, 9p

مصطلحات موضوعية: CORONARY artery bypass, MYOCARDIAL infarction, MAJOR adverse cardiovascular events, PROPENSITY score matching, CORONARY artery disease

مستخلص: Open in new tab Download slide OBJECTIVES Left main coronary artery disease (LMCAD) is considered an independent risk factor for clinical events after coronary artery bypass grafting (CABG). We have conducted a subgroup analysis of the multicentre European DuraGraft Registry to investigate clinical event rates at 1 year in patients with and without LMCAD undergoing isolated CABG in contemporary practice. METHODS Patients undergoing isolated CABG were selected. The primary end point was the incidence of a major adverse cardiac event (MACE) defined as the composite of death, myocardial infarction (MI) or repeat revascularization (RR) at 1 year. The secondary end point was major adverse cardiac and cerebrovascular events (MACCE) defined as MACE plus stroke. Propensity score matching was performed to balance for differences in baseline characteristics. RESULTS LMCAD was present in 1033 (41.2%) and absent in 1477 (58.8%) patients. At 1 year, the MACE rate was higher for LMCAD patients (8.2% vs 5.1%, P  = 0.002) driven by higher rates of death (5.4% vs 3.4%, P  = 0.016), MI (3.0% vs 1.3%, P  = 0.002) and numerically higher rates of RR (2.8% vs 1.8%, P  = 0.13). The incidence of MACCE was 8.8% vs 6.6%, P  = 0.043, with a stroke rate of 1.0% and 2.4%, P  = 0.011, for the LMCAD and non-LMCAD groups, respectively. After propensity score matching, the MACE rate was 8.0% vs 5.2%, P  = 0.015. The incidence of death was 5.1% vs 3.7%, P  = 0.10, MI 3.0% vs 1.4%, P  = 0.020, and RR was 2.7% vs 1.6%, P  = 0.090, for the LMCAD and non-LMCAD groups, respectively. Less strokes occurred in LMCAD patients (1.0% vs 2.4%, P  = 0.017). The MACCE rate was not different, 8.5% vs 6.7%, P  = 0.12. CONCLUSIONS In this large registry, LMCAD was demonstrated to be an independent risk factor for MACE after isolated CABG. Conversely, the risk of stroke was lower in LMCAD patients. Clinical trial registration number ClinicalTrials.gov NCT02922088. [ABSTRACT FROM AUTHOR]

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المؤلفون: Sandner, Sigrid^1,2 (AUTHOR), Redfors, Björn³ (AUTHOR), Angiolillo, Dominick J.⁴ (AUTHOR), Audisio, Katia⁵ (AUTHOR), Fremes, Stephen E.^6,7 (AUTHOR), Janssen, Paul W.A.⁸ (AUTHOR), Kulik, Alexander⁹ (AUTHOR), Mehran, Roxana¹⁰ (AUTHOR), Peper, Joyce⁸ (AUTHOR), Ruel, Marc¹¹ (AUTHOR), Saw, Jacqueline^12,13 (AUTHOR), Soletti, Giovanni Jr⁵ (AUTHOR), Starovoytov, Andrew¹² (AUTHOR), ten Berg, Jurrien M.⁸ (AUTHOR), Willemsen, Laura M.⁸ (AUTHOR), Zhao, Qiang¹⁴ (AUTHOR), Zhu, Yunpeng¹⁴ (AUTHOR), Gaudino, Mario⁵ (AUTHOR) mfg9004@med.cornell.edu

المصدر: JAMA: Journal of the American Medical Association. 8/9/2022, Vol. 328 Issue 6, p554-562. 9p.

مصطلحات موضوعية: *SAPHENOUS vein, *RESEARCH, *CORONARY artery bypass, *CLINICAL trials, *META-analysis, *RESEARCH methodology, *SYSTEMATIC reviews, *SURGICAL complications, *MEDICAL care, *EVALUATION research, *TREATMENT effectiveness, *VASCULAR grafts, *CARDIOVASCULAR system, *COMPARATIVE studies, *PLATELET aggregation inhibitors, *ASPIRIN, *HEMORRHAGE, PREVENTION of surgical complications

مستخلص: Importance: The role of ticagrelor with or without aspirin after coronary artery bypass graft surgery remains unclear.Objective: To compare the risks of vein graft failure and bleeding associated with ticagrelor dual antiplatelet therapy (DAPT) or ticagrelor monotherapy vs aspirin among patients undergoing coronary artery bypass graft surgery.Data Sources: MEDLINE, Embase, and Cochrane Library databases from inception to June 1, 2022, without language restriction.Study Selection: Randomized clinical trials (RCTs) comparing the effects of ticagrelor DAPT or ticagrelor monotherapy vs aspirin on saphenous vein graft failure.Data Extraction and Synthesis: Individual patient data provided by each trial were synthesized into a combined data set for independent analysis. Multilevel logistic regression models were used.Main Outcomes and Measures: The primary analysis assessed the incidence of saphenous vein graft failure per graft (primary outcome) in RCTs comparing ticagrelor DAPT with aspirin. Secondary outcomes were saphenous vein graft failure per patient and Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding events. A supplementary analysis included RCTs comparing ticagrelor monotherapy with aspirin.Results: A total of 4 RCTs were included in the meta-analysis, involving 1316 patients and 1668 saphenous vein grafts. Of the 871 patients in the primary analysis, 435 received ticagrelor DAPT (median age, 67 years [IQR, 60-72 years]; 65 women [14.9%]; 370 men [85.1%]) and 436 received aspirin (median age, 66 years [IQR, 61-73 years]; 63 women [14.5%]; 373 men [85.5%]). Ticagrelor DAPT was associated with a significantly lower incidence of saphenous vein graft failure (11.2%) per graft than was aspirin (20%; difference, -8.7% [95% CI, -13.5% to -3.9%]; OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001) and was associated with a significantly lower incidence of saphenous vein graft failure per patient (13.2% vs 23.0%, difference, -9.7% [95% CI, -14.9% to -4.4%]; OR, 0.51 [95% CI, 0.35 to 0.74]; P < .001). Ticagrelor DAPT (22.1%) was associated with a significantly higher incidence of BARC type 2, 3, or 5 bleeding events than was aspirin (8.7%; difference, 13.3% [95% CI, 8.6% to 18.0%]; OR, 2.98 [95% CI, 1.99 to 4.47]; P < .001), but not BARC type 3 or 5 bleeding events (1.8% vs 1.8%, difference, 0% [95% CI, -1.8% to 1.8%]; OR, 1.00 [95% CI, 0.37 to 2.69]; P = .99). Compared with aspirin, ticagrelor monotherapy was not significantly associated with saphenous vein graft failure (19.3% vs 21.7%, difference, -2.6% [95% CI, -9.1% to 3.9%]; OR, 0.86 [95% CI, 0.58 to 1.27]; P = .44) or BARC type 2, 3, or 5 bleeding events (8.9% vs 7.3%, difference, 1.7% [95% CI, -2.8% to 6.1%]; OR, 1.25 [95% CI, 0.69 to 2.29]; P = .46).Conclusions and Relevance: Among patients undergoing coronary artery bypass graft surgery, adding ticagrelor to aspirin was associated with a significantly decreased risk of vein graft failure. However, this was accompanied by a significantly increased risk of clinically important bleeding. [ABSTRACT FROM AUTHOR]

المؤلفون: Sandner, Sigrid E¹ (AUTHOR) sigrid.sandner@meduniwien.ac.at, Donovan, Terrence John² (AUTHOR), Edelstein, Stav³ (AUTHOR), Puskas, John D⁴ (AUTHOR), Angleitner, Philipp¹ (AUTHOR), Krasopoulos, George⁵ (AUTHOR), Channon, Keith⁶ (AUTHOR), Gehrig, Thomas² (AUTHOR), Rajakaruna, Cha⁷ (AUTHOR), Ladyshenskij, Leonid⁸ (AUTHOR), Silva, Ravi De⁹ (AUTHOR), Bonaros, Nikolaos¹⁰ (AUTHOR), Bolotin, Gil¹¹ (AUTHOR), Jacobs, Stephan¹² (AUTHOR), Thielmann, Matthias¹³ (AUTHOR), Choi, Yeong-Hoon¹⁴ (AUTHOR), Ohri, Sunil¹⁵ (AUTHOR), Lipey, Alexander¹⁶ (AUTHOR), Friedrich, Ivar² (AUTHOR), Taggart, David P⁵ (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Jul2022, Vol. 62 Issue 1, p1-9. 9p.

مصطلحات موضوعية: *CORONARY artery bypass, *VEIN diseases, *INTRAVASCULAR ultrasonography, *CORONARY angiography, *HARVESTING, *SAPHENOUS vein

مستخلص: Open in new tab Download slide OBJECTIVES In a post hoc analysis of the VEST III trial, we investigated the effect of the harvesting technique on saphenous vein graft (SVG) patency and disease progression after coronary artery bypass grafting. METHODS Angiographic outcomes were assessed in 183 patients undergoing open (126 patients, 252 SVG) or endoscopic harvesting (57 patients, 114 SVG). Overall SVG patency was assessed by computed tomography angiography at 6 months and by coronary angiography at 2 years. Fitzgibbon patency (FP I, II and III) and intimal hyperplasia (IH) in a patient subset were assessed by coronary angiography and intravascular ultrasound, respectively, at 2 years. RESULTS Baseline characteristics were similar between patients who underwent open and those who underwent endoscopic harvesting. Open compared with endoscopic harvesting was associated with higher overall SVG patency rates at 6 months (92.9% vs 80.4%, P = 0.04) and 2 years (90.8% vs 73.9%, P = 0.01), improved FP I, II and III rates (65.2% vs 49.2%; 25.3% vs 45.9%, and 9.5% vs 4.9%, respectively; odds ratio 2.81, P = 0.09) and reduced IH area (-31.8%; P = 0.04) and thickness (-28.9%; P = 0.04). External stenting was associated with improved FP I, II and III rates (odds ratio 2.84, P = 0.01), reduced IH area (-19.5%; P < 0.001) and thickness (-25.0%; P < 0.001) in the open-harvest group and reduced IH area (-12.7%; P = 0.01) and thickness (-9.5%; P = 0.21) in the endoscopic-harvest group. CONCLUSIONS A post-hoc analysis of the VEST III trial showed that open harvesting is associated with improved overall SVG patency and reduced IH. External stenting reduces SVG disease progression, particularly with open harvesting. [ABSTRACT FROM AUTHOR]

المؤلفون: Gaudino, Mario¹ mfg9004@med.cornell.edu, Sandner, Sigrid², Di Giammarco, Gabriele³, Di Franco, Antonino¹, Hirokuni Arai⁴, Tohru Asai⁵, Bakaeen, Faisal⁶, Doenst, Torsten⁷, Fremes, Stephen E.⁸, Glineur, David⁹, Kieser, Teresa M.¹⁰, Lawton, Jennifer S.¹¹, Lorusso, Roberto¹², Patel, Nirav¹³, Puskas, John D.¹⁴, Tatoulis, James¹⁵, Taggart, David P.¹⁶, Vallely, Michael¹⁷, Ruel, Marc¹⁸, Arai, Hirokuni¹⁹ (AUTHOR)

المصدر: Circulation. 10/5/2021, Vol. 144 Issue 14, p1160-1171. 12p.

مصطلحات موضوعية: *CORONARY artery surgery, *CORONARY artery bypass, *ARTERIAL grafts, *FLOW measurement, *TIME measurements, *EXPERT evidence, *SURGICAL therapeutics, *SYSTEMATIC reviews, *ROUTINE diagnostic tests, *CARDIOVASCULAR disease diagnosis

مستخلص: Transit time flow measurement (TTFM) allows quality control in coronary artery bypass grafting but remains largely underused, probably because of limited information and the lack of standardization. We performed a systematic review of the evidence on TTFM and other methods for quality control in coronary artery bypass grafting following PRISMA standards and elaborated expert recommendations by using a structured process. A panel of 19 experts took part in the consensus process using a 3-step modified Delphi method that consisted of 2 rounds of electronic voting and a final face-to-face virtual meeting. Eighty percent agreement was required for acceptance of the statements. A 2-level scale (strong, moderate) was used to grade the statements based on the perceived likelihood of a clinical benefit. The existing evidence supports an association between TTFM readings and graft patency and postoperative clinical outcomes, although there is high methodological heterogeneity among the published series. The evidence is more robust for arterial, rather than venous, grafts and for grafts to the left anterior descending artery. Although TTFM use increases the duration and the cost of surgery, there are no data to quantify this effect. Based on the systematic review, 10 expert statements for TTFM use in clinical practice were formulated. Six were approved at the first round of voting, 3 at the second round, and 1 at the virtual meeting. In conclusion, although TTFM use may increase the costs and duration of the procedure and requires a learning curve, its cost/benefit ratio seems largely favorable, in view of the potential clinical consequences of graft dysfunction. These consensus statements will help to standardize the use of TTFM in clinical practice and provide guidance in clinical decision-making. [ABSTRACT FROM AUTHOR]

المؤلفون: Gaudino, Mario, Franco, Antonino Di, Bhatt, Deepak L, Alexander, John H, Abbate, Antonio, Azzalini, Lorenzo, Sandner, Sigrid, Sharma, Garima, Rao, Sunil V, Crea, Filippo, Fremes, Stephen E, Bangalore, Sripal

المصدر: European Heart Journal; 4/7/2021, Vol. 42 Issue 14, p1433-1441, 9p

مصطلحات موضوعية: CORONARY heart disease treatment, CARDIAC patients, CORONARY artery bypass, ARTERIAL occlusions, TRANSPLANTATION of organs, tissues, etc.

مستخلص: The concept of a direct association between coronary graft patency and clinical status is generally accepted. However, the relationship is more complex and variable than usually thought. Key issues are the lack of a common definition of graft occlusion and of a standardized imaging protocol for patients undergoing coronary bypass surgery. Factors like the type of graft, the timing of the occlusion, and the amount of myocardium at risk, as well as baseline patients' characteristics, modulate the patency-to-clinical status association. Available evidence suggests that graft occlusion is more often associated with non-fatal events rather than death. Also, graft failure due to competitive flow is generally a benign event, while graft occlusion in a graft-dependent circulation is associated with clinical symptoms. In this systematic review, we summarize the evidence on the association between graft status and clinical outcomes. [ABSTRACT FROM AUTHOR]

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المؤلفون: Schaefer, Andreas, Conradi, Lenard, Schneeberger, Yvonne, Reichenspurner, Hermann, Sandner, Sigrid, Tebbe, Ulrich, Nowak, Bernd, Stritzke, Jan, Kastrati, Adnan, Schunkert, Heribert, Scheidt, Moritz von, investigators, for the TiCAB

المصدر: European Journal of Cardio-Thoracic Surgery; Feb2021, Vol. 59 Issue 2, p417-425, 9p

مصطلحات موضوعية: CORONARY artery bypass, TREATMENT effectiveness, CEREBRAL revascularization, PERCUTANEOUS coronary intervention, ANGINA pectoris, CARDIOVASCULAR disease related mortality

مستخلص: Open in new tab Download slide Open in new tab Download slide OBJECTIVES In this post hoc analysis of the Ticagrelor in coronary artery bypass grafting (CABG) trial, we aimed to analyse patients treated with CABG receiving either complete revascularization (CR) or incomplete revascularization (ICR) independent from random allocation to either ticagrelor or aspirin. METHODS Of 1859 patients enrolled in the Ticagrelor in CABG trial, 1550 patients (83.4%) received CR and 309 patients (16.6%) ICR. Outcomes were evaluated regarding all-cause mortality, cardiovascular death, myocardial infarction (MI), repeat revascularization, stroke and bleeding within 12 months after CABG. RESULTS Baseline parameters revealed significant differences regarding clinical presentation (stable angina pectoris: CR 68.9% vs ICR 71.2%, instable angina pectoris: 14.1% vs 7.8%, non-ST elevation MI: 17.0% vs 21.0%, P ˂ 0.01), lesion characteristics (chronic total occlusion: CR 91.3% vs ICR 96.8%, P ˂ 0.01), operative technique [off-pump coronary artery bypass surgery (OPCAB): CR 3.0% vs ICR 6.1%, P ˂ 0.01] and number of utilized grafts (total number of grafts: 2.69/patient vs 2.49/patient, P ˂ 0.001). ICR patients displayed a significantly increased risk of repeat revascularization [hazard ratio (HR) 1.91, 95% confidence interval (CI) 1.16–3.16; P  < 0.01] and percutaneous coronary intervention (HR 1.95, 95% CI 1.13–3.35; P  < 0.05) within 12 months after CABG. Higher risk for repeat revascularization in ICR patients was independent from random allocation to either ticagrelor or aspirin and persisted after adjustment for baseline imbalances. CONCLUSIONS Patients with ICR presented more stable at the time of admission, but received less grafts, highly likely due to a higher rate of chronic total occlusion lesions and performed OPCAB. Although mortality presented no difference between groups, our results suggest that patients benefit from CR with regard to prevention of repeat revascularization. [ABSTRACT FROM AUTHOR]

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المؤلفون: Gaudino, Mario F L¹ (AUTHOR) mfg9004@med.cornell.edu, Sandner, Sigrid² (AUTHOR), Bonalumi, Giorgia³ (AUTHOR), Lawton, Jennifer S⁴ (AUTHOR), Fremes, Stephen E⁵ (AUTHOR), Surgery, in collaboration with the Coronary Task Force of the European Association for Cardio-Thoracic (AUTHOR)

المصدر: European Journal of Cardio-Thoracic Surgery. Dec2020, Vol. 58 Issue 6, p1111-1117. 7p.

مصطلحات موضوعية: *CORONARY artery bypass, *ARTERIAL grafts, *INTERNAL thoracic artery, *RADIAL artery, *MYOCARDIAL revascularization, SURGERY practice

الشركة/الكيان: EUROPEAN Society of Cardiology

مستخلص: Open in new tab Download slide Open in new tab Download slide Observational evidence shows that the use of multiple arterial grafts (MAG) is associated with longer postoperative survival and improved clinical outcomes. The current European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines on myocardial revascularization recommend the use of MAG in appropriate patients. However, a significant volume-to-outcome relationship exists for MAG, and lack of sufficient experience is associated with increased operative risk. A stepwise approach to building experience with MAG allows successful implementation of this technique into routine coronary surgery practice. [ABSTRACT FROM AUTHOR]

المؤلفون: Wollner, Gregor, Zimpfer, Daniel, Manduric, Marina, Laufer, Günther, Rieger, Armin, Sandner, Sigrid E.

المصدر: Journal of Cardiac Surgery; Oct2020, Vol. 35 Issue 10, p2543-2549, 7p, 5 Charts, 3 Graphs

مصطلحات موضوعية: HIV infections, CORONARY artery bypass, HIGHLY active antiretroviral therapy, HIV infection complications, STROKE, SURGICAL complications, CARDIOVASCULAR diseases, RETROSPECTIVE studies, MYOCARDIAL infarction, TREATMENT effectiveness, CORONARY artery disease, DISEASE complications

الشركة/الكيان: MEDIZINISCHE Universitat Wien

مستخلص: Background: With early and effective antiretroviral therapy and improved survival for persons living with human immunodeficiency virus infection (PLHIV), this patient population now faces an increasingly elevated risk of cardiovascular disease. However, the data on outcomes after coronary artery bypass grafting (CABG) for revascularization of coronary artery disease (CAD) in HIV+ patients is limited.Methods: We conducted a retrospective analysis of 16 patients undergoing isolated CABG at the Medical University of Vienna from 2005 to 2018, who were HIV+ on admission. The primary endpoint of the study was survival. Secondary endpoints included the components of major adverse cardiac and cerebrovascular events (MACCE): cardiovascular death, stroke, myocardial infarction (MI), and repeat revascularization.Results: Patients were followed for a median of 49 months (range, 7-142 months). Survival was 100% and 90% at 1 and 3 years after CABG, respectively. There were no strokes. MI and subsequent repeat revascularization were observed in two patients.Conclusion: CABG provides excellent short- and midterm survival and freedom from MACCE in HIV+ patients with CAD requiring revascularization. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Cardiac Surgery is the property of Hindawi Limited and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Sandner, Sigrid¹ (AUTHOR), Gaudino, Mario² (AUTHOR) mfg9004@med.cornell.edu

المصدر: Journal of Cardiac Surgery. Aug2021, Vol. 36 Issue 8, p2802-2804. 3p.

مصطلحات موضوعية: *ACUTE coronary syndrome, *TICAGRELOR, *CORONARY artery bypass, *MYOCARDIAL infarction, *ATHEROSCLEROSIS, *REOPERATION, *CORONARY artery disease

مستخلص: Given the lack of established benefit, routine P2Y12 receptor inhibitor pretreatment in NSTE-ACS is not recommended in patients in whom the coronary anatomy is not known and early invasive management is planned, although it may be considered for patients with delayed invasive management.3 However, P2Y12 receptor inhibitor pretreatment may increase bleeding risk and delay surgery after diagnostic angiography in patients for whom CABG is indicated. In addition, in studies investigating the association of P2Y12 receptor inhibitors and perioperative bleeding risk a surgical bleeding site was identified in up to 55% of patients undergoing reoperation for bleeding,5,14 potentially confounding reports of increased bleeding with ticagrelor. Hansson et al.10 studied the incidence of CABG-related bleeding using the Bleeding Academic Research Consortium (BARC) classification11 in relation to P2Y12 receptor inhibitor discontinuation periods in a retrospective analysis of 2244 ACS patients referred for CABG on DAPT with either ticagrelor or clopidogrel. [Extracted from the article]