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NSTE-ACS Dual Antiplatelet Pre-Treatment: the portuguese experience
Session:
Posters (Sessão 5 - Écran 4) - Síndromes Coronárias Agudas - tratamento farmacológico
Speaker:
António Maria Rocha de Almeida
Congress:
CPC 2023
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:
Pósters Electrónicos
FP Number:
---
Authors:
António Maria Rocha De Almeida; Miguel Carias Sousa; Rita Rocha; Francisco Cláudio; Marta Paralta Figueiredo; Kisa Congo; Manuel Trinca; Em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Background</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Decision of which antithrombotic therapy strategy scheme for non-persistent ST-segment elevation acute coronary syndromes (NSTE-ACS) remains controversial. European Cardiology Society guidelines ceased recommending pretreatment with P2Y12 receptor inhibitor in NSTE-ACS, based on <em><span style="font-family:"Calibri",sans-serif">Accoast </span></em><em><span style="font-family:"Calibri",sans-serif">Trial</span></em>, which demonstrated absence of ischemic benefits and higher bleeding risk. However, sample studied didn’t illustrate Portuguese reality.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Material and methods</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Cohort of 2194 NSTE-ACS patients from a multicenter national registry, treated according standard of care, between 2010-2019, was compared with <em><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Accoast </span></span></span></em><em><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Trial</span></span></span></em><em> </em><span style="background-color:white"><span style="color:black">1996 results of patients no pretreatment sample<em><span style="font-family:"Calibri",sans-serif">.</span></em></span></span> </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="font-family:"Calibri",sans-serif"><span style="color:black">Results and conclusions</span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">There was no statistically significant difference on age, sex distribution, aspirin or antithrombin therapy. 96.5% of Portuguese group were pretreated with dual antiplatelet therapy (DAPT).</span> <span style="font-family:"Calibri",sans-serif">Trial’s sample had median time to coronary angiography (CA) of 4.2 hours and femoral access in 57.0% and Portuguese group had a median time of 12h-36h till CA, and femoral access in 11.6%. Just 0.7% had urgent surgery in Portuguese sample. There was more cardiovascular caused deaths, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa bailout (9.8%) on trial’s sample, against only 5.0% on Portuguese group. Pretreatment group had slighter increase, with no statistical significance, of TIMI major bleeding (1.8%vs1.4%), with median timing 3.5 days after. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Earlier CA may explain trial’s absence of ischemic benefits. Later bleeding complications might be associated with DAPT strategy itself, and not with timing. Due to lack availability, surgery wasn’t done before 5 days. Hence, DAPT pretreatment should not be for chose all NSTE-ACS, nevertheless, can be valid option, according to bleeding and ischemic risk, CA timing, access, or surgery availability.</span></span></span></p>
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