Key result
Pre-CABG P2Y12 inhibitor washout linked to ~0.8% rate of pre-revascularization recurrent MI and death.
Why the study?
The risk of recurrent myocardial infarction or death in ACS patients pretreated with P2Y12 inhibitors undergoing invasive coronary angiography and considered for urgent CABG was unclear.
Observational (n=262)
No
There is a small but clinically meaningful 0.8% risk of recurrent myocardial infarction and mortality in patients with acute coronary syndromes facing surgical delays due to necessary oral P2Y12 inhibitor washout prior to urgent CABG.
This retrospective single-centre observational study included 262 sequential patients with acute coronary syndromes (ACS) undergoing invasive coronary angiography (ICA) while receiving P2Y12 inhibitors and considered for coronary artery bypass graft surgery (CABG); P2Y12 inhibitors (ticagrelor 91%, thienopyridine 9%) were stopped prior to CABG. The primary outcome was recurrent myocardial infarction or death following ICA and prior to revascularisation or decision for conservative management. 2 patients (0.8%) had recurrent MI and died following ICA and prior to planned CABG, demonstrating a small risk of MI and death in patients who have delays to CABG following ICA for ACS.
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Lim et al. (2026) conducted an observational in Acute coronary syndromes (n=262). Cessation of P2Y12 inhibitors prior to urgent CABG was evaluated on Composite of cardiovascular events (stroke, MI, heart failure) and all-cause mortality following invasive coronary angiography and prior to revascularisation. Among patients with acute coronary syndromes pretreated with P2Y12 inhibitors, 0.8% experienced recurrent myocardial infarction and died during the delay required for antiplatelet washout prior to urgent CABG.
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