Older case series highlighted a potential excess mortality risk for CABG when performed early after STEMI, which was related to worsen- ing myocardial injury from cardiopulmonary bypass, aortic cross-clamping, and cardioplegic arrest, with hemorrhagic transformation and infarct expansion. However, contemporary modifications to the standard operative approach, such as on- pump beating-heart surgery, off-pump techniques, or adjunctive temporary mechanical circulatory support devices, may lead to improved survival rates after CABG in the acute hospital phase. 7.2. Timing of Urgent CABG in Patients With STEMI in Relation to Use of Antiplatelet Agents: Recommendations Class I 1. Aspirin should not be withheld before urgent (Level of Evidence: C) 2. Clopidogrel or ticagrelor should be discontinued at least 24 hours before urgent on-pump CABG, if pos- (Level of Evidence: B) 3. Short-acting intravenous GP IIb/IIIa receptor antag- onists (eptifibatide, tirofiban) should be discontinued at least 2 to 4 hours before urgent CABG.405,406 (Level of Evidence: B) 4. Abciximab should be discontinued at least 12 hours before urgent CABG.362 (Level of Evidence: B) Class IIb 1. Urgent off-pump CABG within 24 hours of clopido- grel or ticagrelor administration might be consid- ered, especially if the benefits of prompt revascular- ization outweigh the risks of bleeding.401,407 409 (Level of Evidence: B) 2. Urgent CABG within 5 days of clopidogrel or ti- cagrelor administration or within 7 days of prasu- grel administration might be considered, especially if the benefits of prompt revascularization outweigh the risks of bleeding. 