Key result
P2Y12 pretreatment before CABG in NSTE-ACS is linked to ~0.8 days longer preoperative but equal total stay.
Why the study?
Routine P2Y 12 inhibitor pretreatment is not recommended for NSTE-ACS patients undergoing early invasive strategy due to lack of improved outcomes and increased bleeding risk, but its impact on length of stay and costs in those requiring CABG is unclear.
Does P2Y12 inhibitor pretreatment affect length of stay, cost, or discharge destination in patients with NSTE-ACS who undergo CABG?
Cohort (n=188)
No
Does P2Y12 inhibitor pretreatment affect length of stay, cost, or discharge destination in patients with NSTE-ACS who undergo CABG?
Absolute Event Rate: 4.2% vs 3.4%
p-value: p=0.019
P2Y12 inhibitor pretreatment in NSTE-ACS patients requiring CABG prolongs preoperative length of stay without affecting total hospital stay or costs, supporting guidelines against routine pretreatment.
Pretreatment was associated with longer preoperative stay without shortening total LOS; leaves open effects on costs or discharge in NSTE-ACS CABG.
Introduction: Recent clinical practice guidelines do not recommend routine P2Y 12 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 P2Y 12 inhibitor washout to reduce periprocedural bleeding risk, potentially prolonging hospitalization and increasing costs. We sought to study the association of P2Y 12 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 P2Y 12 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, P2Y 12 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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Wahlberg et al. (2025) conducted a cohort in Non-ST-elevation acute coronary syndromes (NSTE-ACS) requiring CABG (n=188). P2Y12 inhibitor pretreatment vs. No P2Y12 inhibitor pretreatment was evaluated on Preoperative length of stay (days) (p=0.019). P2Y12 inhibitor pretreatment in patients with NSTE-ACS undergoing CABG was associated with a longer preoperative length of stay (4.2 vs. 3.4 days, p=0.019), but no difference in total length of stay.
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