P2Y12 adenosine receptor inhibitors preloading among patients with non‐ST‐elevation acute coronary syndromes; insights from a nationwide multicenter registry

Author:

Arow Ziad12ORCID,Shmueli Hezzy34,Koifman Edward12ORCID,Barashi Rami12ORCID,Assali Abid12,Mahajna Luham56,Orvin Katia27ORCID,Beigel Roy28,Abramowitz Yigal34,Tsaban Gal34

Affiliation:

1. Meir Medical Center Heart Institute Kfar Saba Israel

2. Faculty of Medicine Tel‐Aviv University Tel Aviv Israel

3. Department of Cardiology Soroka University Medical Center Beersheva Israel

4. Faculty of Health Sciences Ben Gurion University of the Negev Beersheva Israel

5. Emek Medical Center Heart Institute Afula Israel

6. Rappaport Faculty of Medicine, Technion Haifa Israel

7. Department of Cardiology Rabin Medical Center Petach Tikva Israel

8. The Leviev Heart Center Sheba Medical Center Ramat Gan Israel

Abstract

AbstractBackgroundThe safety and efficacy of treatment with P2Y12 adenosine‐diphosphate receptor inhibitors (P2Y12‐RI) before coronary angiography among patients with non‐ST‐segment elevation acute coronary syndromes (NSTEACS) are questionable.AimsTo assess the pretreatment rate with P2Y12‐RI and its association with ischemic and bleeding risks among patients with NSTEACS.MethodsThe study comprised patients with NSTEACS referred for coronary angiography and included in the Acute Coronary Syndrome Israeli Surveys between 2013 and 2021. Patients were divided into two groups according to the timing of P2Y12‐RI loading concerning coronary angiography: pretreatment and posttreatment. The primary endpoints were 30‐day major adverse cardiovascular events (MACE; composite of cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, and urgent revascularization) and 1‐year all‐cause mortality.ResultsOf 3076 patients, 2423 (78.8%) received pretreatment with a P2Y12‐RI, and 653 (21.2%) received P2Y12‐RI posttreatment. Prasugrel and ticagrelor were used more in the posttreatment group compared to the pretreatment group (16% vs. 6% and 38% vs. 25%, respectively, p < 0.001 for both). No difference was observed in the rate of 30‐day MACE comparing pretreatment and posttreatment (5.3% vs. 2.2%, respectively, p = 0.62). A sensitivity analysis of 30‐day MACE among patients from the 2021 survey demonstrated similar results (2.5% in the posttreatment group vs. 8.0% in the pretreatment group, p = 0.13). There were no differences in 1‐year all‐cause mortality rates between the pretreatment and posttreatment groups (4.8% vs. 3.8%, p = 0.31).ConclusionsAmong patients with NSTEACS referred for an invasive strategy, the P2Y12‐RI posttreatment strategy was associated with similar 30‐day and 1‐year MACE as the pretreatment strategy. These large‐scale, multicenter, real‐world data provide reassurance on the safety and efficacy of delaying P2Y12‐IR until after coronary stratification to improve clinical decision‐making.

Publisher

Wiley

Reference18 articles.

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3. Antithrombotic therapy in the early phase of non-ST-elevation acute coronary syndromes: a systematic review and meta-analysis

4. Effects of Clopidogrel in Addition to Aspirin in Patients with Acute Coronary Syndromes without ST-Segment Elevation

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