The Association of P2Y12 Inhibitor Pretreatment With Length of Stay Among Patients With Acute Coronary Syndrome Who Underwent Coronary Artery Bypass Graft Surgery: A Cohort Study

Abstract

The cardiothoracic surgery program at our rural, tertiary academic medical center performed on average 257 CABG surgeries per year during the study period. Analysis of variance was used to assess for differences in length of stay for pretreated patients, multivariate linear regression for differences in cost of hospitalization, and multivariable logistic regression for discharge destination (home vs. rehabilitation facility) and bleeding outcomes. Exploratory Analysis During the study period in February 2021, an institutional policy was enacted recommending against routine pretreatment of outpatients presenting for elective coronary angiography. Patients receiving pretreatment ( n=145) Patients not receiving pretreatment ( n=43) p-value Age, median (IQR) 66.7 (58.9–73.3) 67.3 (54.7–75.3) 0.91 Female gender, # (%) 27 (18.6) 9 (20.9) 0.74 Race/ethnicity^ (%)  White, non-Hispanic 131 (95.6) 38 (95.0) 0.06  Black, non-Hispanic 1 (0.7) 0 (0.0)  Asian/other/unknown, non-Hispanic 5 (3.7) 0 (0.0)  Hispanic 0 (0.0) 2 (5.0) Payer, # (%)  Commercial 41 (28.3) 10 (23.3) 0.59  Medicare 80 (55.2) 23 (53.5)  Medicaid 15 (10.3) 7 (16.3)  Self-pay 1 (0.7) 1 (2.3)  Other 8 (5.5) 2 (4.7) STS risk, mean (SD)  STS mortality risk 1.6 (2.0) 1.9 (2.2) 0.39  STS morbidity & mortality risk 10.8 (10.7) 11.5 (8.2) 0.32  STS long length of stay risk ∗ 4.2 (5.6) 4.6 (4.8) 0.43 Discharge disposition: home, # (%) 122 (81.4) 35 (84.1) 0.67 Note: Continuous variables were evaluated using Wilcoxon rank sum tests and categorical variables via Chi-square or Fisher’s exact test. 3.1.