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

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.