Is Loading NSTEMI with DAPT Convenient?

Pretreating non-ST elevation acute myocardial infarction (NSTEMI) patients with P2Y12 receptor inhibitors is not associated with improved clinical outcomes as it is to increased bleeding.

NSTEMI patients are often treated with platelet antiaggregants in the daily clinical practice despite the lack of evidence for its benefits.

This Swedish registry prospectively included 64857 patients undergoing NSTEMI receiving coronary angiography plus angioplasty between 2010 and 2018.

Propensity score matching was used to match patient cohorts between patients pretreated with P2Y12 inhibitors and those who did not.

92.4% of this large cohort of patients received one P2Y12 receptor antagonist, including clopidogrel (43.7%), ticagrelor (54.5%) and prasugrel (1.8%).

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Pretreatment was not associated to benefits in terms of 30-day mortality (OR: 1.17; CI 95%, 0.66 to 2.11; p=0.58), mortality at one year (OR: 1.34; CI 95%, 0.77 to 2.34; p=0.30) or stent thrombosis (OR: 0.81; CI 95%, 0.42 to 1.55; p=0.52).

Pretreatment did produce increased in-hospital bleeding in nearly 50% of patients (OR: 1.49; CI 95%, 1.06 to 2.12; p=0.02).

Conclusion

Pretreatment with P2Y12 Receptor Antagonists Preceding Percutaneous Coronary Intervention in Non–ST-Segment Elevation Acute Coronary Syndromes does not bring clinical benefits and increases bleeding. This study strongly recommends against routine pretreatment of these group of patients with P2Y12 receptor antagonists before knowing their anatomy.

Original Title: Association of Pretreatment With P2Y12 Receptor Antagonists Preceding Percutaneous Coronary Intervention in Non–ST-Segment Elevation Acute Coronary Syndromes With Outcomes.

Reference: Christian Dworeck et al. JAMA Network Open. 2020;3(10):e2018735. doi:10.1001/jamanetworkopen.2020.18735.

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