SPC365

Prognostic implications of P2Y12 inhibitor pretreatment in non-ST segment elevation acute coronary syndromes undergoing late invasive strategy - a national registry analysis

Session: Sessão de Posters 36 - Antiagregação plaquetar
Speaker: Adriana da Fonseca Vazão

Congress: CPC 2024
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: Cartazes
FP Number: ---
Authors: Adriana Vazão; Carolina Gonçalves; André Martins; Mariana Carvalho; Margarida Cabral; João Carvalho; Sidarth Pernencar; João Morais; Em Nome de Todos os Investigadores do Registo Nacional de Síndromes Coronárias Agudas

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Background: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Current guidelines recommend considering P2Y12 pre-treatment (PreT) in patients (pts) with non-ST segment elevation acute coronary syndrome (NSTE-ACS) expected to undergo a late invasive strategy, based on individual bleeding risk.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Purpose: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Describe in-hospital morbi-mortality in NSTE-ACS pts undergoing a late invasive strategy (coronary angiography (CAG) performed &gt;24h post-admission) comparing those receiving P2Y12 inhibitors (P2Y12i) PreT with those who did not. </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Methods: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Retrospective multicenter analysis of NSTE-ACS pts from the Portuguese Registry on Acute Coronary Syndromes (ProACS) undergoing a late invasive strategy (2010-2023). Exclusion criteria: prior treatment with P2Y12i or anticoagulants; atrial fibrillation. Two cohorts were defined PreT with P2Y12i before undergoing CAG (group 1) and without PreT (group 2) with comparative analyses of baseline characteristics, clinical and CAG findings, and treatment. Primary outcome was in-hospital major adverse cardiac events (MACE), a composite of all-cause mortality, re-infarction, stroke and congestive heart failure. Secondary outcomes were individual events and major bleeding. </span></span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Results: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">3776 pts were included (mean age:66&plusmn;12yrs,29% female) of whom 1530 (41%) received PreT (group 1). Group 1 had lower prevalence of dyslipidemia (60vs66%), prior myocardial infarction (16vs21%) and percutaneous coronary intervention (12vs15%) (all p&le;0.001). &nbsp;On admission, there were no differences in Killip class (class I - 90%) but group 1 less frequently had left ventricular disfunction (ejection fraction &lt;50% - 20vs24%,p=0.032). Group 1 had higher incidence of obstructive coronary disease (84vs77%,p&lt;0.001), more frequently needed more than 1 CAG (8vs4%,p&lt;0.001), but multivessel disease did not differ significantly (52vs52%,p=0.667). Coronary angioplasty was more frequent in group 1 (63vs60%,p=0.019) as was coronary artery bypass graft (13vs10%,p=0.002). Regarding anti-thrombotics, group 1 had higher prescription of clopidogrel (68vs56%), aspirin (99vs81%), unfractionated heparin (21vs8%) and enoxaparin (80vs56%)(all p&lt;0.001). There were no differences in primary outcome (9vs9%) and secondary outcomes (table 1B). Group 1 had higher rates of major bleeding (0.8 vs 0.2%,OR 3.48,CI 95% 1.22-9.89,p=0.013).</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">Conclusions: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:&quot;PT Serif&quot;,serif"><span style="color:#222222">In patients with NSTE-ACS undergoing a late invasive strategy, PreT with P2Y12i showed no significant differences in in-hospital MACE despite association with higher rates of major bleeding. </span></span></span></span></span></span></p>