Percutaneous coronary intervention without P2Y 12 inhibitor pretreatment: A real-life study

2018 
Objective Recent studies have challenged systematic pretreatment with a P2Y 12  inhibitor before percutaneous coronary intervention (PCI) in elective and non-ST-segment elevation myocardial infarction (NSTEMI) patients. The aim of this study was to assess outcomes after performing PCI immediately after coronary angiography with an exclusive ‘on-the-table’ P2Y 12  inhibitor loading dose, by evaluating ischaemic and bleeding complications in unselected patients. Methods Consecutive patients admitted for elective PCI or NSTEMI were included in this bicentric, prospective observational study, and received a P2Y 12  inhibitor after coronary angiography when PCI was decided. The primary composite endpoint was first occurrence of cardiovascular death, myocardial infarction, stroke, urgent revascularisation or use of bailout glycoprotein IIb/IIIa inhibitors at 30 days after PCI. Stent thrombosis and bleedings (Bleeding Academic Research Consortium [BARC]) criteria were evaluated. Results Among 299 included patients, 188 were admitted for elective PCI and 111 for NSTEMI. The incidence of the primary endpoint was 8.5% (95% CI 5.7 to 12.4). No definite stent thrombosis occurred. Three independent predictive factors were associated with the primary endpoint: NSTEMI setting (OR 5.61 (95% CI 1.75 to 17.98), thrombotic coronary lesion (OR 4.26 (95% CI 1.45 to 12.54) and longer procedure duration (OR 1.06 (95% CI 1.03 to 1.09). Clinically relevant bleedings (BARC type 2, 3 or 5) occurred in 5.4% of patients. Conclusions In an unselected population admitted for elective PCI or NSTEMI in real-life practice, administration of a P2Y 12  inhibitor only after coronary angiography is associated with a low rate of ischaemic and bleeding events at 30 days.
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