Evidence map›Paper›PMID 39969871›Full record

Trial reportJAMA surgery2025

Early vs Delayed Bypass Surgery in Patients With Acute Coronary Syndrome Receiving Ticagrelor: The RAPID CABG Randomized Open-Label Noninferiority Trial.

Derek Y F So, George A Wells, Marie Lordkipanidzé, Aun Yeong Chong, Marc Ruel, Louis P Perrault, Michel R Le May, Louise Sun, Diem Tran, Marino Labinaz and 9 more

Registry-linked trialAbstract readComparative StudyEquivalence TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in JAMA surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02668562 (Reassessment of Anti-Platelet Therapy Using InDividualized Strategies -Ticagrelor in Patients With Acute Coronary Syndromes Treated by Coronary Artery Bypass Graft Surgery - A Pharmacodynamic and Clinical Study to Decrease Bleeding Risks and Ischemic Complications - The RAPID-TITRATE CABG Study), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02668562 nacompletednot on this map

Reassessment of Anti-Platelet Therapy Using InDividualized Strategies -Ticagrelor in Patients With Acute Coronary Syndromes Treated by Coronary Artery Bypass Graft Surgery - A Pharmacodynamic and Clinical Study to Decrease Bleeding Risks and Ischemic Complications - The RAPID-TITRATE CABG Study

TypeinterventionalSponsorOttawa Heart Institute Research CorporationRan2016 to 2022Enrolled143ConditionsAcute Coronary SyndromeArmsEarly CABG (Day 2-3 after ticagrelor discontinuation), Delayed CABG (Day 5-7 after ticagrelor discontinuation)
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Review
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors.

Derek Y F SoDivision of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
George A WellsCardiovascular Research Methods Centre, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Marie LordkipanidzéMontreal Heart Institute Research Centre, Montreal, Quebec, Canada.
Aun Yeong ChongDivision of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Marc RuelDivision of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Louis P PerraultDivision of Cardiac Surgery, Department of Surgery, Montreal Heart Institute, Montreal, Quebec, Canada.
Michel R Le MayDivision of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Louise SunDivision of Cardiac Anesthesia, Department of Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Diem TranDivision of Cardiac Anesthesia, Department of Anesthesiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Marino LabinazDivision of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Christopher GloverDivision of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Juan RussoDivision of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Mélanie WelmanMontreal Heart Institute Research Centre, Montreal, Quebec, Canada.
Vincent ChanDivision of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Lily ChenCardiovascular Research Methods Centre, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Jordan BernickCardiovascular Research Methods Centre, Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Fraser RubensDivision of Cardiac Surgery, Department of Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Jean-Francois TanguayDepartment of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada.
RAPID CABG Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Perioperative bleeding is a major concern in patients receiving ticagrelor for acute coronary syndromes (ACS) when coronary artery bypass graft (CABG) surgery is required. Objective: To evaluate whether early CABG surgery at 2 to 3 days after ticagrelor cessation is noninferior to waiting 5 to 7 days. Design, Setting, and Participants: RAPID CABG was a noninferiority, open-label randomized trial with 6 months of follow-up. Participants were patients with ACS who had received ticagrelor and required CABG. Patients were enrolled in tertiary centers in Canada between January 2016 and March 2021. Data were analyzed from March 2021 to December 2023. Intervention: Early or delayed CABG. Main Outcomes and Measures: The primary outcome was based on noninferiority comparison of class 3 or 4 universal definition of perioperative bleeding (UDPB). Noninferiority was prespecified as 8% between groups. Twelve-hour chest tube drainage was reported as a noninferiority comparison. Other bleeding, ischemic, and length-of-stay outcomes were assessed for superiority. Results: Among 143 randomized patients, the median (IQR) age was 65 (58-72) years; there were 117 male patients (82%) and 26 female (18%). Of these, 123 patients (86.0%) underwent surgery in the allocated time frame (per protocol). The median (IQR) time to surgery was 3 (2-3) days in the early group and 6 (5-7) days in the delayed group (P < .001). In a per-protocol analysis, severe or massive UDPB occurred in 3 of 65 early-group patients (4.6%) and 3 of 58 patients (5.2%) in the delayed group (between-group difference, -0.6%; 95% CI, -8.3% to 7.1%; P = .03 for noninferiority). Median (IQR) chest tube drainage was 470 (330-650) mL vs 495 (380-610) mL (between-group difference -25 mL; 95% CI, -111.25 to 35; P = .01 for noninferiority). Median (IQR) hospital stay was 9 (7-13) days and 12 (10-15) days for the early and delayed groups (P < .001). Conclusion and Relevance: This study found that an early surgical strategy, 2 to 3 days after ticagrelor cessation, was noninferior in incurring perioperative bleeding. The data support a reduction in the delay between ticagrelor cessation and CABG surgery and may decrease hospital length of stay. Trial Registration: ClinicalTrials.gov Identifier: NCT02668562.

Indexed as

Acute Coronary SyndromeCoronary Artery BypassPlatelet Aggregation InhibitorsPostoperative HemorrhageTicagrelorTime-to-TreatmentAgedFemaleHumansMaleMiddle AgedTime FactorsTreatment OutcomePlatelet Aggregation InhibitorsTicagrelor

Identifiers

PMID39969871
PMCPMC11840690

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.