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Ticagrelor pretreatment in invasively managed patients with non-ST elevation acute coronary syndrome
Session:
Painel 7 - Doença Coronária 8
Speaker:
Luís Graça Santos
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Luís Graça Santos; Rita Ribeiro Carvalho; Sara Lopes Fernandes; Fernando Montenegro Sá; Catarina Ferreira Ruivo; Francisco Soares; Joana Correia; Sidarth Pernencar; Joao Morais
Abstract
<p><strong>Introduction:</strong> Dual antiplatelet therapy is recommended in non-ST elevation acute coronary syndrome (NSTACS), regardless of the treatment strategy (invasive vs. conservative). Although prasugrel pretreatment is not recommended due to safety concerns, the timing of ticagrelor administration is still debated.</p> <p><strong>Aim: </strong>To investigate the clinical effects of ticagrelor pretreatment in NSTACS patients (pts) undergoing percutaneous coronary intervention.</p> <p><strong>Methods: </strong>Retrospective multicentre study of 5213 NSTACS pts who underwent percutaneous coronary intervention (PCI) up to 72 hours following hospital admission, between January 2013 and December 2018. Patients with prior chronic exposure to oral antithrombotics (except acetylsalicylic acid), not acutely managed with ticagrelor, and those with missing data were excluded. A total of 415 pts were included for analysis: 256 (61.6%) received ticagrelor pretreatment (Group 1) and 159 (38.3%) were treated with ticagrelor only in the catheterization laboratory (Group 2). The primary safety endpoint was a composite of in-hospital major bleeding, need for red blood cell transfusion or haemoglobin drop ≥2g/dL and the secondary endpoint of periprocedural events was a composite of PCI failure, bailout use of GPIIb/IIIa inhibitors and in-hospital re-infarction. Multivariate analysis was performed to determine the correlates of ticagrelor pretreatment and each of the endpoints. One-year follow up was achieved in 103 pts (24.8%).</p> <p><strong>Results: </strong>Overall, mean age was 62±11 years and 20.7% were female. Crude event rates did not differ regarding primary endpoint (16.5 vs 11.5%; p=0.17), while secondary endpoint was more frequent among group 2 (2.1% vs 7.1%; p=0.01). Multivariate analysis showed no association between the timing of ticagrelor administration and the primary safety endpoint, while periprocedural events were less frequent in pretreated pts (Figure 1A). At the Kaplan-Meier analysis, one-year cumulative event-free (all-cause death, stroke or re-infarction) rates did not differ (Figure 1B).</p> <p><strong>Conclusion:</strong> In this cohort of NSTACS pts undergoing PCI in the first 72 hours after hospital admission, ticagrelor pretreatment was associated with less periprocedural events with no compromise regarding safety, compared to treatment only in the catheterization laboratory. Additional data is still needed to clarify these findings.</p>
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