https://doi.org/10.1007/s00392-025-02625-4
1Universitätsklinikum Heidelberg Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie Heidelberg, Deutschland; 2Atos Praxisklinik Zentrum für Gefäßerkrankungen und Präventivmedizin Heidelberg, Deutschland
Background. Serious bleeding events after coronary artery bypass grafting (CABG) have significant implications on patient outcomes. Current, guidelines recommend a withdrawal of dual antiplatelet therapy (DAPT) before cardiac surgery and opt against routine pre-treatment with a P2Y12 receptor (P2Y12 RA) antagonist before coronary angiography. Thus, the current study aimed to evaluate the prevalence of bleeding events and respective DAPT therapy in patients with an acute coronary artery syndrome (ACS) requiring a CABG after presenting in an emergency department setting.
Methods. In this retrospective observational single-center study, consecutively presenting ACS patients between 1st of July 2016 and 30th of June 2018 to the CPU of the University Hospital of Heidelberg requiring a CABG operation after presentation were enrolled. Baseline characteristics, CABG related bleeding events and 90-day all-cause mortality were accessed retrospectively from electronical medical records.
Results. Within a total of 1,502 ACS patients, 102 (6.8%) underwent urgent CABG. Owing local standards, the majority received a routine P2Y12-RA pre-treatment in addition to low dose aspirin before CA. A total of 31 (30.4%) developed a CABG related bleeding event. Bleeding probability was highest, when CABG was performed within 24 hours after administration of dual anti platelet therapy (DAPT). Despite high utilization rates of DAPT pre-treatment and high prevalence of CABG-related major bleedings, no fatal bleedings occurred.
Conclusions. The need of an urgent CABG treatment in ACS patients is infrequent and does not result in an excess of all-cause mortality. However, cessation of P2Y12-RA for at least 48 hours before CABG is required to minimize rates of CABG-related bleedings.