Precatheterization Use of P2Y12 Inhibitors in Non-ST-Elevation Myocardial Infarction Patients Undergoing Early Cardiac Catheterization and In-Hospital Coronary Artery Bypass Grafting: Insights From the National Cardiovascular Data Registry®

Background: current guidelines recommend early p2y12 inhibitor administration in non-st-elevation myocardial infarction,but it is unclear if precatheterization use is associated with longer delays to coronary artery bypass grafting (cabg) or higher risk of post-cabg bleeding and transfusion. this study examines the patterns and outcomes of precatheterization p2y12 inhibitor use in non-st-elevation myocardial infarction patients who undergo cabg.methods and results: retrospective analysis was done of 20 304 non-st-elevation myocardial infarction patients in the action (acute coronary treatment and intervention outcomes network) registry (2009-2014) who underwent catheterization within 24 hours of admission and cabg during the index hospitalization. using inverse probability-weighted propensity adjustment,we compared time from catheterization to cabg,post-cabg bleeding,and transfusion rates between patients who did and did not receive precatheterization p2y12 inhibitors. among study patients,32.9% received a precatheterization p2y12 inhibitor (of these,2.2% were given ticagrelor and 3.7% prasugrel). time from catheterization to cabg was longer among patients who received precatheterization p2y12 inhibitor (median 69.9 hours [25th,75th percentiles 28.2,115.8] versus 43.5 hours [21.0,71.8],p<0.0001),longer for patients treated with prasugrel (median 114.4 hours [66.5,155.5]) or ticagrelor (90.4 hours [48.7,124.5]) compared with clopidogrel (69.3 [27.5,114.6],p<0.0001). precatheterization p2y12 inhibitor use was associated with a higher risk of post-cabg major bleeding (75.7% versus 73.4%,adjusted odds ratio 1.33,95% confidence interval 1.22-1.45,p<0.0001) and transfusion (47.6% versus 35.7%,adjusted odds ratio 1.51,95% confidence interval 1.41-1.62,p<0001); these relationships did not differ among patients treated with clopidogrel,prasugrel,or ticagrelor.conclusions: precatheterization p2y12 inhibitor use occurs commonly among non-st-elevation myocardial infarction patients who undergo early catheterization and in-hospital cabg. despite longer delays to surgery,the majority of pretreated patients proceed to cabg <3 days postcatheterization. precatheterization p2y12 inhibitor use is associated with higher risks of postoperative bleeding and transfusion. © 2017 the authors. published on behalf of the american heart association,inc.,by wiley.