The Association of P2Y12 Inhibitor Pretreatment With Length of Stay Among Patients With Acute Coronary Syndrome Who Underwent Coronary Artery Bypass Graft Surgery: A Cohort Study

IF 3.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Therapeutics Pub Date : 2025-04-08 DOI:10.1155/cdr/8959128

Kramer J. Wahlberg, Cyrus Thomas-Walker, Bradley J. Tompkins, Juvena Hitt, Allen B. Repp, William Hopkins

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引用次数: 0

Abstract

Introduction: Recent clinical practice guidelines do not recommend routine P2Y₁₂ inhibitor pretreatment for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) treated with an early invasive strategy based upon clinical trial data suggesting no improvement in clinical outcomes and increased risk of bleeding. A subset of patients with NSTE-ACS who receive pretreatment and subsequently require coronary artery bypass graft (CABG) surgery may require lengthy P2Y₁₂ inhibitor washout to reduce periprocedural bleeding risk, potentially prolonging hospitalization and increasing costs. We sought to study the association of P2Y₁₂ inhibitor pretreatment on value-based outcomes including length of stay, cost, and discharge destination.

Methods: We conducted a retrospective cohort study of patients presenting with NSTE-ACS who underwent CABG at a tertiary academic medical center between 2019 and 2021. We assessed the frequency of P2Y₁₂ inhibitor pretreatment over the study period and compared risk-adjusted length of stay, cost of hospitalization, and discharge destination among patients who did or did not receive pretreatment.

Results: One hundred eighty-eight patients met inclusion criteria, and 77% received pretreatment. The rate of pretreatment decreased significantly over the study period (p < 0.001). Pretreatment was associated with longer preoperative length of stay (4.2 ± 1.6 vs. 3.4 ± 2.5 days, p = 0.019), with no significant difference in postoperative or total length of stay. There was no difference in cost of hospitalization or likelihood of discharge to home following CABG.

Conclusion: Among patients presenting with NSTE-ACS who underwent inpatient CABG, P2Y₁₂ inhibitor pretreatment was associated with longer preoperative length of stay, but no difference in total length of stay, cost of hospitalization, or discharge destination in this observational, single-center study.

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急性冠状动脉综合征患者行冠状动脉搭桥手术后P2Y12抑制剂预处理与住院时间的关系：一项队列研究

近期临床实践指南不推荐对非st段抬高急性冠脉综合征（NSTE-ACS）患者采用早期侵入性治疗策略进行常规P2Y12抑制剂预处理，基于临床试验数据显示临床结果没有改善，出血风险增加。一部分接受预处理并随后需要冠状动脉旁路移植术（CABG）的NSTE-ACS患者可能需要长时间的P2Y12抑制剂洗脱以降低术中出血风险，这可能会延长住院时间并增加费用。我们试图研究P2Y12抑制剂预处理与基于价值的结果的关系，包括住院时间、费用和出院目的地。方法：我们对2019年至2021年间在三级学术医疗中心接受CABG治疗的NSTE-ACS患者进行了回顾性队列研究。我们评估了研究期间P2Y12抑制剂预处理的频率，并比较了接受或未接受预处理的患者的经风险调整的住院时间、住院费用和出院目的地。结果：188例患者符合纳入标准，77%的患者接受了预处理。预处理率在研究期间显著下降(p <；0.001)。预处理与术前住院时间延长相关（4.2±1.6天vs. 3.4±2.5天，p = 0.019），术后或总住院时间无显著差异。CABG后住院费用和出院回家的可能性没有差异。结论：在接受住院CABG的NSTE-ACS患者中，P2Y12抑制剂预处理与术前住院时间延长相关，但在总住院时间、住院费用或出院目的地方面没有差异。

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来源期刊

Cardiovascular Therapeutics 医学-心血管系统

CiteScore

5.60

自引率

0.00%

发文量

审稿时长

6 months

期刊介绍： Cardiovascular Therapeutics (formerly Cardiovascular Drug Reviews) is a peer-reviewed, Open Access journal that publishes original research and review articles focusing on cardiovascular and clinical pharmacology, as well as clinical trials of new cardiovascular therapies. Articles on translational research, pharmacogenomics and personalized medicine, device, gene and cell therapies, and pharmacoepidemiology are also encouraged. Subject areas include (but are by no means limited to): Acute coronary syndrome Arrhythmias Atherosclerosis Basic cardiac electrophysiology Cardiac catheterization Cardiac remodeling Coagulation and thrombosis Diabetic cardiovascular disease Heart failure (systolic HF, HFrEF, diastolic HF, HFpEF) Hyperlipidemia Hypertension Ischemic heart disease Vascular biology Ventricular assist devices Molecular cardio-biology Myocardial regeneration Lipoprotein metabolism Radial artery access Percutaneous coronary intervention Transcatheter aortic and mitral valve replacement.