Implementation of the Third Universal Definition of Myocardial Infarction After Coronary Artery Bypass Grafting: A Survey Study in Western Europe

Background: Clinical outcomes in acute coronary syndrome patients treated with P2Y12 inhibitors who require urgent coronary artery bypass grafting (CABG) have not been well studied. Methods: We examined clinical outcomes in acute coronary syndrome patients in relation to the timing of CABG following P2Y12 inhibitor discontinuation (<72 h, 72 h to five days, >5 days). The primary ischemic outcome was a composite of death, reinfarction, need for revascularization, or stroke. The primary safety outcome was bleeding of at least moderate severity as defined by a Universal Definition of Perioperative Bleeding class ≥2. Results: Among 508 patients (95 ticagrelor, 413 clopidogrel), the timing of CABG following P2Y12 inhibitor discontinuation was <72 h in 32.1%, 72 h to five days in 23.2% and >5 days in 44.7%. Compared with CABG within 72 h, CABG 72 h to five days (adjusted odds ratio (OR) 0.35; 95% confidence interval (CI) 0.14–0.85; p=0.02) but not >5 days (adjusted OR 0.62; 95% CI 0.33–1.16; p=0.14) after P2Y12 inhibitor discontinuation was associated with lower odds of the primary ischemic outcome. Compared with CABG within 72 h, CABG 72 h to five days (adjusted OR 0.38; 95% CI 0.22–0.66; p=0.001) and >5 days (adjusted OR 0.33; 95% CI 0.20–0.53; p<0.001) after P2Y12 inhibitor discontinuation were associated with lower rates of Universal Definition of Perioperative Bleeding class ≥2 bleeding. Conclusions: CABG within 72 h after P2Y12 inhibitor discontinuation is associated with excess ischemia and bleeding. The rates of ischemic and bleeding events were comparable in patients undergoing CABG 72 h to five days compared with >5 days after P2Y12 inhibitor discontinuation.

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Absence of perioperative excessive bleeding in on-pump coronary artery bypass grafting cases performed by residents

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz195 ◽

2019 ◽

Vol 29 (6) ◽

pp. 836-843

Author(s):

Piotr Mazur ◽

Radosław Litwinowicz ◽

Łukasz Krzych ◽

Maciej Bochenek ◽

Grzegorz Wasilewski ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Artery Bypass ◽

Bleeding Risk ◽

Bypass Grafting ◽

Perioperative Bleeding ◽

Pump Cabg ◽

Pump Coronary Artery Bypass ◽

Universal Definition ◽

Definition Of

Abstract OBJECTIVES On-pump coronary artery bypass grafting (CABG) is associated with elevated bleeding risk. Our aim was to evaluate the role of surgical experience in postoperative blood loss. METHODS A propensity score-matched analysis was employed to compare on-pump CABG patients operated on by residents and specialists. End points included drainage volume and bleeding severity, as assessed by the Universal Definition of Perioperative Bleeding in cardiac surgery and E-CABG scale. RESULTS A total of 212 matched pairs (c-statistics 0.693) were selected from patients operated on by residents (n = 294) and specialists (n = 4394) between October 2012 and May 2018. Patients did not differ in bleeding risk. There were no statistically significant differences in postoperative 6-, 12- and 24-h drainages between subjects operated on by residents and specialists, and there was no between-group difference in rethoracotomy or transfusion rate. There were no differences in Universal Definition of Perioperative Bleeding or E-CABG grades. In June 2018, after a median follow-up of 2.8 years (range 0.1–5.7 years), the overall survival was 94%, with no differences between the patients operated on by residents (95%) and specialists (92%) (P = 0.27). CONCLUSIONS Patients undergoing on-pump CABG, when operated on by a resident, are not exposed to an elevated bleeding risk, as compared with patients operated on by experienced surgeons.

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Optimal Timing of Coronary Artery Bypass Grafting in Hemodynamically Stable Patient After Myocardial Infarction and Definition of Poor Prognostic Factors. Pilot Study

Case Medical Research ◽

10.31525/ct1-nct03863158 ◽

2019 ◽

Author(s):

Keyword(s):

Myocardial Infarction ◽

Prognostic Factors ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Pilot Study ◽

Artery Bypass ◽

Optimal Timing ◽

Bypass Grafting ◽

Stable Patient ◽

Definition Of

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Haemostatic Factors and Inhibitors and Coronary Artery Bypass Grafting: Preoperative Alterations and Relations to Graft Occlusion

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648867 ◽

1994 ◽

Vol 72 (03) ◽

pp. 335-342 ◽

Cited By ~ 34

Author(s):

Elisabeth Moor ◽

Anders Hamsten ◽

Margareta Blombäck ◽

Istvan Herzfeld ◽

Björn Wiman ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Factor Vii ◽

Bypass Grafting ◽

Graft Occlusion ◽

Artery Bypass Grafting ◽

The Third ◽

Haemostatic Factors

SummaryGraft closure remains a major problem after coronary artery bypass surgery. While a number of graft characteristics influencing the risk of occlusion have been defined, the role of haemostatic factors and inhibitors has not been studied in detail. The present study examined the time course of changes in blood coagulation and fibrinolytic function after coronary artery bypass grafting in 20 consecutive patients. Pre- and postoperative determinations of haemostatic factors and inhibitors were also related to the presence of graft occlusion assessed by angiography at three months after surgery. A broad panel of haemostatic tests was used preoperatively, on the first, third and eight postoperative days, and at three months after surgery. A particular emphasis was placed on fibrinogen, factor VII activity, von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1) activity, anticoagulant proteins C and S, thrombin-antithrombin complex and D-dimer. A marked activation of the coagulation cascade was noted postoperatively along with enhanced degradation of cross-linked fibrin. The degree of activation of blood coagulation and fibrinolysis differed widely between individuals and appeared to relate only partly to the acute phase reaction produced by the surgical trauma. Preoperative values of haemostatic factors and inhibitors showed fairly weak associations with the levels of postoperative determinations. Basal tPA and factor VIII levels, fibrinogen and TAT concentrations on the third and eighth postoperative day, and factor VII amidolytic activity on the third postoperative day differed (p <0.05) between patients with and without occluded grafts at reangiography. Accordingly, combined pre- and postoperative assessment of haemostatic function may contribute to the identification of individuals at risk for early graft closure after coronary artery bypass grafting.

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