Coronary Artery Bypass Graft Surgery (CABG)
CABG in Patients With STEMI
ÎÎUrgent CABG is indicated in patients with STEMI and coronary
anatomy not amenable to PCI who have ongoing or recurrent ischemia,
cardiogenic shock, severe HF, or other high-risk features. (I-B)
ÎÎCABG is recommended in patients with STEMI at time of operative
repair of mechanical defects. (I-B)
ÎÎThe use of mechanical circulatory support is reasonable in patients
with STEMI who are hemodynamically unstable and require urgent
CABG. (IIa-C)
ÎÎEmergency CABG within 6 hours of symptom onset may be considered
in patients with STEMI who do not have cardiogenic shock and are not
candidates for PCI or fibrinolytic therapy. (IIb-C)
Timing of Urgent CABG in Patients With STEMI in Relation to
Use of Antiplatelet Agents
ÎÎAspirin should not be withheld before urgent CABG. (I-C)
ÎÎClopidogrel or ticagrelor should be discontinued at least 24 hours
before urgent on-pump CABG, if possible. (I-B)
ÎÎShort-acting intravenous GP IIb/IIIa receptor antagonists (eptifibatide,
tirofiban) should be discontinued at least 2-4 hours before urgent
CABG. (I-B)
ÎÎAbciximab should be discontinued at least 12 hours before urgent
CABG. (I-B)
ÎÎUrgent off-pump CABG within 24 hours of clopidogrel or ticagrelor
administration might be considered, especially if the benefits of
prompt revascularization outweigh the risks of bleeding. (IIb-B)
ÎÎUrgent CABG within 5 days of clopidogrel or ticagrelor administration
or within 7 days of prasugrel administration might be considered,
especially if the benefits of prompt revascularization outweigh the
risks of bleeding. (IIb-C)
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