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Impact of P2Y12 inhibitors pretreatment on delay to coronary surgery in a real-world population with NSTE-ACS
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Daniel A. Gomes
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.6 Acute Coronary Syndromes - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Daniel A. Gomes; Bruno Rocha; Rita Reis Santos; Mariana Sousa Paiva; Marina Raquel Santos; Gonçalo Cunha; João Presume; Jorge Ferreira; Pedro de Araújo Gonçalves; José Neves; Rui Campante Teles; Manuel de Sousa Almeida; Marisa Trabulo; Carlos Aguiar; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Times New Roman,Times,serif"><strong>Background:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Times New Roman,Times,serif">The most recent guidelines recommend against the pretreatment with P2Y12 inhibitors (P2Y12i) in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) undergoing coronary angiography (CA) in the first 24h. The rationale is, in part, to prevent the delay of coronary artery bypass graft surgery (CABG) in patients with suitable coronary anatomy. This study aims to analyze the impact of this recommendation in a real-world population.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Times New Roman,Times,serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Times New Roman,Times,serif">In this single-centre retrospective analysis, we reviewed all admitted NSTE-ACS patients in 2019 who underwent CA. Every patient received P2Y12i pretreatment. Patients with prior CABG (n=31) and patients without obstructive disease (n=57) were excluded. Enrolled patients were characterized according to the performance of CABG during index hospitalization. CABG under the effect of P2Y12i was defined as surgery performed within 5 days after CABG Uni- and multivariate analyses were performed, using indication for CABG as the outcome.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Times New Roman,Times,serif"><strong>Results:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Times New Roman,Times,serif">Total cohort included 262 patients, mean age 68±12 years, 69% male, mean GRACE score 134±35 and 15% with unstable angina. A total of 61 patients discussed in Heart Team for surgery generated 45 in-hospital CABG. In multivariate analysis, previous percutaneous coronary intervention (PCI) (OR 1.94 [95% CI 1.04-3.62], p=0.036) and diabetes mellitus (OR 2.39 [95% CI 1.32-4.36], p=0.004) were independent predictors of indication for CABG before CA (figure 1). Contrarily, age and GRACE score (≤ 140 versus > 140) did not differentiate those with surgical indication (16.6% vs. 18.8%, p=0.656). Median time from CA to CABG was 12 (7-15) days and 5 (11%) patients underwent surgery under P2Y12i effect. Two patients (4.3%) assigned to CABG died before surgery (on day 1 and 6 post-CA) and 3 patients died in-hospital after CABG (days 19, 31 and 120 after CABG). Non-fatal major bleeding occurred in 1 out of 5 patients undergoing surgery under P2Y12i effect.</span></span></p> <p style="text-align:justify"> </p> <p><span style="font-size:14px"><span style="font-family:Times New Roman,Times,serif"><strong>Conclusions:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Times New Roman,Times,serif">In a real-world NSTE-ACS population, the use of P2Y12i before CA was a non-dominant driver of CABG delay. Previous PCI and diabetes mellitus were independent predictors of indication for CABG. </span></span></p>
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