• ACS
• bleeding
• CABG
• CAD
• Cangrelor
• DAPT
• PCI
• thrombosis

Objectives: to evaluate the safety and efficacy of intravenous P2Y12-inhibitors as bridge to coronary artery bypass grafting (CABG) after primary percutaneous coronary intervention (PCI).
Methods: the study included all patients with coronary artery disease (CAD) who underwent CABG after PCI, at the University of Pisa, from January 2021 to May 2025. We divided patients in 3 groups: group 1 patients who discontinued oral dual antiplatelet therapy (DAPT) at least 3 days before CABG without bridging; group 2 patients who bridged DAPT with intravenous P2Y12-inhibitor before CABG; group 3 control group of patients who underwent CABG under single antiplatelet oral therapy. The primary outcomes were all-cause mortality, myocardial infarction, surgical revision for bleeding, the number of transfused red blood cells (RBC) units, and hemoglobin drop after CABG. Results were also compared to literature.
Results: all variables were homogeneously distributed across the three treatment groups, except for the type of cardiovascular disease. The Cangrelor group showed a higher proportion of patients with STEMI and unstable angina as acute event (the proportions of patients with STEMI were 39%, 50%, and 17% in the DAPT, Cangrelor, and oral antiplatelet therapy groups, respectively; the proportions of patients with unstable angina were 6%, 15%, and 9%, respectively; p = 0.024), as well as in the time elapsed since stent implantation (less than 30 days: 5.6%, 38.5%, and 0% in the DAPT, Cangrelor, and oral antiplatelet therapy groups, respectively; p = 0.002). Across the entire sample, 49 patients experienced adverse events; 15 patients experienced one adverse event, and 3 patients experienced two adverse events. No statistically significant heterogeneity was observed in the distribution of adverse events between the DAPT and Cangrelor groups. However, a higher frequency of patients requiring more than five units of transfused blood was observed in the DAPT group compared to the Cangrelor group, although this difference did not reach statistical significance at the 5% level (p = 0.103); the difference was statistically significant when comparing DAPT with both other treatment groups combined (p = 0.028). A random-effects meta-analysis was conducted to evaluate the risk of myocardial infarction, bleeding, and all-cause mortality as reported in the literature.
Conclusions: based on our findings, patients characteristics were mostly balanced: adverse event rates were similar between DAPT and Cangrelor, with a trend toward higher transfusion needs in the DAPT group. Results align with existing literature