Impact of P2Y12 Inhibitors Pretreatment on Stent Thrombosis in Patients Undergoing Percutaneous Coronary...

The optimal timing for initiating P2Y12 inhibitor therapy in patients undergoing percutaneous coronary intervention (PCI) remains controversial. In this study we analyzed the impact of dual antiplatelet therapy (DAPT) pretreatment on premature stent thrombosis in patients with chronic coronary syndrome and non-ST-elevation myocardial infarction treated by PCI.

We analyzed data from 53,898 PCI procedures (44,412 patients) in the "France PCI" registry between 2014 and 2020. Patients were divided into P2Y12 inhibitor pretreatment (83.2%) and no-pretreatment (16.8%) groups. The primary endpoint was incidence of in-hospital definite stent thrombosis.

Pretreatment was associated with a significantly lower incidence of in-hospital stent thrombosis (0.1% vs 0.4%; odds ratio [OR] 0.35, 95% confidence interval [CI] 0.22-0.57). At 1 year, the pretreatment group showed lower rates of major adverse cardiovascular events (6.6% vs 7.8%; OR 0.83, 95% CI 0.74-0.92) and all-cause mortality (4.6% vs 6.0%; OR 0.71, 95% CI 0.63-0.80). Notably, there was no significant increase in major bleeding events in the pretreatment group.

In this large, real-world cohort, P2Y12 inhibitor pretreatment was associated with a significant reduction in in-hospital stent thrombosis and improved 1-year clinical outcomes without increased major bleeding risk. Our findings suggest that selective use of antiplatelet pretreatment may still play a crucial role in improving ischemic outcomes for patients undergoing PCI.