What is the best antiplatelet in PCI to vein grafts?

Courtesy of Dr. Carlos Fava.

PCI to saphenous vein grafts is one the greatest challenges these days because, as opposed to native arteries, they present important thrombolytic material, diffuse and long lesions, and abundant macrophage and inflammatory cells, which makes the procedure more complex.

ticagrelor vs clopidogrel en enfermedad vascular perifericaAt present, we have not yet agreed on the best antiplatelet drug to indicate, and for how long.

 

This study looked at 8119 patients. 7401 received clopidogrel (91.1%), 221 prasugrel (2.7%) and 497 ticagrelor (6.1%).

 

The three groups had similar characteristics. The use of ticagrelor was increased in time, as the use of prasugrel was reduced.


Read also: More Evidence for the “Forgotten Valve.” Results from the TriValve Registry.


The radial approach and the youngest patients more often received the strongest P2Y12. The use of prasugrel was more frequent in STEMI patients and ticagrelor in non-STEMI patients and some unstable angina cases. The use of protection systems was more frequent in the ticagrelor group and the use of glycoprotein inhibitors was higher in the prasugrel groups.

 

After variable adjusting, there were no differences in 30-day mortality with the different antiplatelets: 1.22 (95% CI: 0.60–2.51) for prasugrel vs clopidogrel 0.48 (95% CI: 0.20–1.16). Neither were there differences in MACE or major bleeding. At one-year follow-up, no differences were found as well.

 

Conclusion

This real-world study does not provide clear evidence to support that the use of potent P2Y12 is associated with improved clinical outcomes at follow-up.

 

Courtesy of Dr. Carlos Fava.

 

Original title: Antiplatelet drug selection in PCI to vein grafts in patients with acute coronary syndrome and adverse clinical outcomes: Insights from the British Cardiovascular Intervention Society database.

Reference: Alex Sirker, et al.  Catheter Cardiovasc Interv. 2018;92:659–665. 


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