Inter-observer Agreement and Variability Using 3D Echocardiography Based Mitral Valve Reconstruction

Abstract

Background: Ticagrelor is an oral, direct, reversible noncompetitive P2Y12 receptor antagonist with rapid and consistent onset and offset of action. The time course of recovery of platelet function following ticagrelor cessation in patients presenting with acute coronary syndrome (ACS) and undergoing surgical revascularisation is yet to be determined. Current guidelines recommend stopping ticagrelor at least 5 days before coronary artery bypass grafting (CABG). However a shorter plasma half-life of ticagrelor (7-12 hours) suggests that this may be longer than necessary. Methods: 46 consecutive ACS patients, who were commenced on aspirin (100 mg) and ticagrelor(180 mg loading and then 90mg twice a day), were referred for CABG after coronary angiography. Immediately after angiography, ticagrelorwas discontinued and inhibition of platelet aggregation (IPA) was assessed daily using the Verify Now P2Y12 assay. Results: Themean agewas 62.37 ( 9.28) years, 78%males. 44% were diabetic. ACS presentations were non ST-elevation myocardial infarction 72%, ST-elevation myocardial infarction 9% and unstable angina 19%. The percentage of patients with IPA 40%) prior to discontinuation. Platelet function recovered by day 3 with 96% recording less than 20% residual IPA (p<0.0001). No significant rebound was noted. Conclusion: The offset of the anti-platelet effects of ticagrelor after its discontinuation in patients with ACS is achieved by day 3. This data suggests an earlier surgical revascularisation strategy than currently recommended in guidelines can be considered.