RAPID CABG
Trial question
Is early surgical strategy noninferior to delayed surgical strategy in patients with acute coronary syndrome receiving ticagrelor?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
19.0% female
81.0% male
N = 140
140 patients (26 female, 114 male).
Inclusion criteria: patients with acute coronary syndrome receiving ticagrelor who required CABG.
Key exclusion criteria: initial stenting for a culprit lesion; need for concurrent valve surgery; requirement of emergent CABG; allergy to aspirin; receipt of OAC; active bleeding; comorbidity with a life expectancy < 1 year.
Interventions
N=71 early surgery (coronary artery bypass surgery at 2-3 days after ticagrelor cessation).
N=69 delayed surgery (coronary artery bypass surgery at 5-7 days after ticagrelor cessation).
Primary outcome
Class 3 or 4 universal definition of perioperative bleeding
4.6%
5.2%
5.2 %
3.9 %
2.6 %
1.3 %
0.0 %
Early
surgery
Delayed
surgery
Difference not exceeding
non-inferiority
margin ✓
Difference not exceeding non-inferiority margin in class 3 or 4 universal definition of perioperative bleeding (4.6% vs. 5.2%; ARD -0.6, 95% CI -8.3 to 7.1).
Secondary outcomes
No significant difference in median chest tube drainage at 12 hours (470 mL vs. 495 mL; MD -25, 95% CI -111.25 to 35).
Significant decrease in median hospital stay (9 days vs. 12 days; AD -3 days, 95% CI -4.78 to -1.22).
No significant difference in receipt of either packed RBC or FFP transfusion (15% vs. 19%; ARD -4, 95% CI -19.7 to 11.7).
Conclusion
In patients with acute coronary syndrome receiving ticagrelor who required CABG, early surgery was noninferior to delayed surgery with respect to class 3 or 4 universal definition of perioperative bleeding.
Reference
Derek Y F So, George A Wells, Marie Lordkipanidzé et al. Early vs Delayed Bypass Surgery in Patients With Acute Coronary Syndrome Receiving Ticagrelor: The RAPID CABG Randomized Open-Label Noninferiority Trial. JAMA Surg. 2025 Feb 19:e247066. Online ahead of print.
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