APPROACH OF WITHHOLDING P2Y12 INHIBITORS FOR URGENT CORONARY ARTERY BYPASS GRAFTING IN DIABETIC PATIENTS WITH ACUTE CORONARY SYNDROME

Abstract

Objectives: To compare angiographic findings between diabetic and non-diabetic patients with acute coronary syndrome (ACS) along with feasibility of P2Y12 inhibitors withholding approach for urgent coronary artery bypass grafting (CABG) in diabetic (DM) patients with severe lesions.

Methodology: Consecutive ACS patients were included. P2Y12 inhibitors was hold in a certain number of diabetic patients with either left main (LM) or multi-vessel disease (MVD) on baseline angiogram, at the discretion of primary physician. Angiographic diseases severity was compared between diabetic and non-diabetics. The clinical management and outcomes of diabetic patients were further compared based on the deferred P2Y12 inhibitors approach.

Results: Out of 205 patients, 149 were males and 40.9% were diabetic. Involved vessel was LM in 19.8% vs. 16.6%; p=0.566, left anterior descending artery (LAD) in 62.8% vs. 39.3%; p=0.001, and right coronary artery in 27.3% vs. 45.2%; p=0.008 with MVD in 42.1% vs. 28.6%, p=0.047 of the diabetic and non-diabetic patients, respectively. P2Y12 inhibitors was hold in 59 diabetic patients who undergone urgent CABG with hospital stay of <5 days. In remaining 62 diabetic patients, 50 undergo coronary intervention and 12 undergo delayed CABG with hospital stay of >5 days due to P2Y12 administration.

Conclusion: The presence of DM showed a significant association with the involvement of the LAD artery. Most participants showed presence of MVD. By holding P2Y12 inhibitors reduces the perioperative bleeding and hospital stay.