P2Y12 Inhibitor Pretreatment in Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing a Late Invasive...

Area of Science:

• Cardiology
• Clinical Medicine
• Pharmacology

Background:

• Current guidelines lack specific recommendations for P2Y12 inhibitor (P2Y12i) pretreatment in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients undergoing a late invasive strategy.
• P2Y12i pretreatment is common despite guideline ambiguity, particularly for patients without high bleeding risk.
• The prognostic impact of this pretreatment strategy requires further investigation.

Purpose of the Study:

• To evaluate the in-hospital prognostic impact of P2Y12 inhibitor pretreatment before coronary angiography (CAG) in NSTE-ACS patients.
• To assess the association between P2Y12i pretreatment and composite in-hospital adverse events.
• To determine the effect of P2Y12i pretreatment on major bleeding events.

Main Methods:

• Retrospective analysis of NSTE-ACS patients from the Portuguese Registry on Acute Coronary Syndromes (2010-2023).
• Inclusion criteria: NSTE-ACS patients undergoing a late invasive strategy (CAG > 24 hours post-admission).
• Primary endpoint: composite of in-hospital all-cause mortality, non-fatal re-infarction, non-fatal stroke, and heart failure; Secondary endpoint: major bleeding (BARC types 3 and 4).

Main Results:

• 41% of 3776 NSTE-ACS patients received P2Y12i pretreatment before a late invasive strategy.
• No significant difference was observed in the primary composite endpoint between pretreated and non-pretreated groups (9% vs. 9%, p=0.906).
• Pretreated patients showed significantly higher rates of major bleeding (0.8% vs. 0.2%, OR 3.48, p=0.013).

Conclusions:

• P2Y12 inhibitor pretreatment in NSTE-ACS patients undergoing a late invasive strategy is not associated with a reduction in key in-hospital adverse events.
• This pretreatment strategy, however, is associated with an increased risk of major bleeding.
• Clinical practice regarding P2Y12i pretreatment in this patient population may warrant re-evaluation.