Meir Medical Center, Heart Institute, Kfar Saba, Israel.
Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Catheter Cardiovasc Interv. 2024 Sep;104(3):499-506. doi: 10.1002/ccd.31143. Epub 2024 Jul 15.
The safety and efficacy of treatment with P2Y12 adenosine-diphosphate receptor inhibitors (P2Y12-RI) before coronary angiography among patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) are questionable.
To assess the pretreatment rate with P2Y12-RI and its association with ischemic and bleeding risks among patients with NSTEACS.
The study comprised patients with NSTEACS referred for coronary angiography and included in the Acute Coronary Syndrome Israeli Surveys between 2013 and 2021. Patients were divided into two groups according to the timing of P2Y12-RI loading concerning coronary angiography: pretreatment and posttreatment. The primary endpoints were 30-day major adverse cardiovascular events (MACE; composite of cardiovascular mortality, myocardial infarction, stroke, stent thrombosis, and urgent revascularization) and 1-year all-cause mortality.
Of 3076 patients, 2423 (78.8%) received pretreatment with a P2Y12-RI, and 653 (21.2%) received P2Y12-RI posttreatment. Prasugrel and ticagrelor were used more in the posttreatment group compared to the pretreatment group (16% vs. 6% and 38% vs. 25%, respectively, p < 0.001 for both). No difference was observed in the rate of 30-day MACE comparing pretreatment and posttreatment (5.3% vs. 2.2%, respectively, p = 0.62). A sensitivity analysis of 30-day MACE among patients from the 2021 survey demonstrated similar results (2.5% in the posttreatment group vs. 8.0% in the pretreatment group, p = 0.13). There were no differences in 1-year all-cause mortality rates between the pretreatment and posttreatment groups (4.8% vs. 3.8%, p = 0.31).
Among patients with NSTEACS referred for an invasive strategy, the P2Y12-RI posttreatment strategy was associated with similar 30-day and 1-year MACE as the pretreatment strategy. These large-scale, multicenter, real-world data provide reassurance on the safety and efficacy of delaying P2Y12-IR until after coronary stratification to improve clinical decision-making.
在非 ST 段抬高型急性冠状动脉综合征（NSTEACS）患者中，在冠状动脉造影前使用 P2Y12 二磷酸腺苷受体抑制剂（P2Y12-RI）的安全性和疗效存在争议。
评估 NSTEACS 患者中 P2Y12-RI 的预处理率及其与缺血和出血风险的关系。
本研究纳入了 2013 年至 2021 年期间因 NSTEACS 接受冠状动脉造影并纳入急性冠状动脉综合征以色列调查的患者。根据 P2Y12-RI 负荷相对于冠状动脉造影的时间，患者被分为预处理组和后处理组：预处理组和后处理组。主要终点为 30 天主要不良心血管事件（MACE；心血管死亡、心肌梗死、卒中和支架血栓形成和紧急血运重建的复合终点）和 1 年全因死亡率。
在 3076 名患者中，2423 名（78.8%）接受了 P2Y12-RI 的预处理，653 名（21.2%）接受了 P2Y12-RI 的后处理。与预处理组相比，后处理组中使用普拉格雷和替格瑞洛的比例更高（分别为 16%比 6%和 38%比 25%，均 < 0.001）。与预处理相比，30 天 MACE 的发生率在预处理组和后处理组之间无差异（分别为 5.3%比 2.2%，p=0.62）。对 2021 年调查中 30 天 MACE 的敏感性分析显示出相似的结果（后处理组为 2.5%，预处理组为 8.0%，p=0.13）。预处理组和后处理组 1 年全因死亡率之间无差异（分别为 4.8%比 3.8%，p=0.31）。
在因侵入性策略而接受治疗的 NSTEACS 患者中，与预处理策略相比，P2Y12-RI 的后处理策略与 30 天和 1 年的 MACE 相似。这些大规模、多中心的真实世界数据为延迟 P2Y12-RI 至冠状动脉分层后以改善临床决策的安全性和疗效提供了保证。
