Antiplatelet Strategies in Non-ST-Segment Elevation Acute Coronary Syndromes

Résumé fourni par la source

Background: There is limited real life information on treatment strategies with P2Y12 receptor inhibitors (P2Y12i) in non-ST-segment elevation acute coronary syndromes (NSTEACS).Objectives: The aim of this study was to determine the incidence of major adverse cardiac events (MACE) and BARC bleeding ≥2, according to the treatment strategy with P2Y12i at 6 months. Methods:The study used the pre-specified subanalysis of the BUENOS AIRES I registry (n=1100).The cohort was stratified according to P2Y12i "pretreatment" (before knowing the coronary anatomy), or "cath lab treatment" (after knowing the coronary anatomy), and the incidence of clinical events was analyzed according to pretreatment or cath lab treatment with clopidogrel/ticagrelor.Results: Mean age was 65.4±11.5 years and 77.2% were male patients.In 79.72% of cases patients received P2Y12i, 75% as pretreatment and 25% as cath lab treatment.Pretreatment patients were younger and with greater prevalence of acute myocardial infarction (AMI) compared with the cath lab treatment subgroup.At 6 months, there were no significant differences in the incidence of MACE (16.4% vs. 14.4%;p=0.508), or BARC bleeding ≥2 (14.7% vs. 11.1%;p=0.205), between the different times of P2Y12i administration.Treatment with ticagrelor presented reduced MACE compared with clopidogrel (p=0.044), with no difference in bleeding.No MACE differences were observed between pretreatment or in cath lab treatment with ticagrelor (p=0.893). Conclusions:The subgroup of patients selected to receive P2Y12i pretreatment did not present differences in MACE or bleeding relative to those treated in cath lab.Patients selected for ticagrelor treatment in cath lab presented a beneficial balance between ischemic and hemorrhagic events.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.