SPC365

STEMI Dual Antiplatelet Pretreatment - Portuguese Multicenter Experience

Session: Sessão de Posters 36 - Antiagregação plaquetar
Speaker: António Maria Rocha de Almeida

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: António Maria Rocha De Almeida; Miguel Carias de Sousa; Marta Paralta Figueiredo; Rafael Viana; Kisa Congo; Rita Rocha; David Neves; Manuel Trinca; Lino Patrício

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Antiplatelet therapy is the cornerstone treatment for ST-segment elevation myocardial infarction (STEMI). Dual antiplatelet therapy (DAPT) including aspirin and a potent P2Y12 inhibitor (P2Y12i) is recommended as default strategy, however, the timing remains controversial: European Cardiology Society ceased to recommend pretreatment with DAPT in STEMI. This study aims to evaluate the effect of DAPT pretreatment with potent P2Y12i in STEMI, in comparison to DAPT with clopidogrel and single antiplatelet treatment (SAPT) with aspirin.</span></span></p>

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

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Methods</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Multicenter national cohort of 2139 STEMI cases was divided in 3 groups, considering its antiplatelet therapy pretreatment: DAPT with potent P2Y12i, DAPT with clopidogrel and SAPT. Primary endpoints were death, major adverse cardiovascular events (MACE), and successful PCI. Safety endpoint was major hemorrhagic events.</span></span></span></span></span></p>

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

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Results</span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">From the total 2139 STEMI patients, 80% (n=1719) were pretreated with DAPT with clopidogrel, with mean age of 65&plusmn;14years and 27% were women. 13% (n=268) patients undergone with DAPT with potent P2Y12i, whom the mean age was 63&plusmn;12years and 21% were female. 7% (n=152) patients were pretreated with aspirin, which the mean age was 72&plusmn;13 years and 38% were women. The DAPT pretreatment groups were statistically significantly younger (p&lt;0,001) and had fewer female patients (p&lt;0,001). In the SAPT group, there was a statistically significant higher rate of history of stroke and chronic kidney disease (15,1% vs 6,8%, p&lt;0,01 and 8,6% vs 4,4%, p=0,03) and of Killip 3 or 4 presentation rate in the aspirin group, against the DAPT group (16,8% vs 7,3%, p&lt;0,01).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">There was a statistically significant decrease in hospital mortality in the DAPT group, comparing with SAPT (11% vs 28%, n=43, p&lt;0,001 OR 0,3 [0,2-0,5] NNT 6), and statistically similar between potent P2Y12i and Clopidogrel (9% vs 11% n=194, p=0,3). The number of MACE was statistically similar between DAPT and SAPT (27% and 33%, p=0,4), however, there was a statistically significant reduction in potent P2Y12i group, comparing with Clopidogrel (15% and 29% p&lt;0,001 OR 0,4 [0,3-0,5] NNT 7). Successful PCI was higher in DAPT group cases, in comparison to SAPT group (73% vs 6%, p&lt;0,01 OR 9 [7-15] NNT 1). Regarding safety outcomes, major hemorrhage occurred in 1,5% (n=5) patients with DAPT with potent P2Y12i, in 3% (n=53) of patients with DAPT with clopidogrel and in 3% (n=4) of aspirin only group of patients. There was no statistically significant difference in terms of hemorrhagic events (p=0,7).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-family:&quot;Calibri&quot;,sans-serif"><span style="color:black">Conclusions</span></span></strong></span></span></span></p>

<p><span style="font-size:12.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">According to our retrospective multicenter results, pretreatment with potent P2Y12i is associated with better results, namely higher rate of successful PCI, less MACE and in hospital death, contrary to recent trials. Our study has some bias, as DAPT pretreatment was standard of care during the registry, and the choice for a SAPT might have been related to higher risk patients</span></span></p>