(P020) COMPARING OUTCOMES OF TICAGRELOR AND CLOPIDOGREL IN ST-ELEVATION MYOCARDIAL INFARCTION PATIENTS REQUIRING CORONARY ARTERY BYPASS GRAFTING DURING INDEX HOSPITALIZATION

Background: Percutaneous coronary intervention (PCI) is the primary reperfusion strategy in ST-Elevation MI (STEMI). However, coronary artery bypass grafting (CABG) continues to play an important role in the revascularization of STEMI patients who have mechanical complications, residual severe disease, or those for whom PCI is incomplete, insufficient, or unsuccessful. Performing CABG during the initial hospitalization for STEMI poses distinct challenges as they frequently require urgent or emergent surgery in the setting of multiple antithrombotic medications. Although superior to clopidogrel for ischemic outcomes, there remains concern for bleeding in patients who received ticagrelor and subsequently require surgery. To better quantify this, we compared ischemic and bleeding outcomes of patients who underwent CABG during their index STEMI hospitalization and received either ticagrelor or clopidogrel as their initial P2Y12 inhibitor.

METHODS AND RESULTS: We screened the University of Ottawa Heart Institute’s primary PCI STEMI database from 2004 to 2018 for patients who underwent CABG during their index STEMI hospitalization and were given a loading dose of either ticagrelor or clopidogrel. Of the 290 identified patients, 168 received Ticagrelor and 122 received clopidogrel prior to their angiogram. Baseline demographics, procedural characteristics, and outcomes of the two groups are shown in Table 1. The median presentation date for patients treated with clopidogrel was September 2009, whereas the median presentation date for those treated with Ticagrelor was May 2016. Treatment with ticagrelor was associated with a decrease in major adverse cardiovascular and cerebrovascular events (MACCE) (6.5% versus 16.4% p=0.01) and a smaller drop in hemoglobin (45.4 ± 17.8 vs 51.8 ± 22.3 p=0.009). There was no difference in the number of patients who required 5 or more units of blood in those treated with ticagrelor compared to clopidogrel (14.9% vs 23.0% p=0.09).

Conclusion: Our retrospective cohort study showed that patients presenting with a STEMI with a planned strategy of primary PCI who received ticagrelor compared to clopidogrel as their initial P2Y12 inhibitor and subsequently underwent inpatient CABG had a decrease in in-hospital MACCE. Patients receiving clopidogrel had a greater absolute drop in hemoglobin. There was no difference in the number of patients who received 5 or more transfusions.