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P2Y12 Inhibitor Pretreatment in Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing a Late Invasive Strategy—A Portuguese Multicenter Nationwide Registry Analysis

2025-09-09Journal article Open access
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dc.contributor.authorVazão, Adriana
dc.contributor.authorGonçalves, Carolina
dc.contributor.authorMartins, André
dc.contributor.authorCarvalho, Mariana
dc.contributor.authorCabral, Margarida
dc.contributor.authorSantos, Luís
dc.contributor.authorPernencar, Sidarth
dc.contributor.authorCarvalho, João
dc.contributor.authorMorais, João
dc.contributor.editorRiordan, Stephen
dc.contributor.editorWang, Dong
dc.date.accessioned2025-11-18T11:18:52Z
dc.date.available2025-11-18T11:18:52Z
dc.date.issued2025-09-09
dc.description(This article belongs to the Special Issue Saving Lives from Myocardial Infarction: Prevention vs. Therapy) The authors would like to express their gratitude to all colleagues and investigators of the ProACS who cooperated in providing data for the current analysis. During the preparation of this manuscript, the authors used ChatGPT v4 for the purposes of text editing (grammar, spelling, punctuation, and formatting). The authors have reviewed and edited the output and assume full responsibility for the content of this publication. Article nr. 2212
dc.description.abstractBackground/Objectives: Current guidelines do not specifically address the use of P2Y12 inhibitor (P2Y12i) pretreatment in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who are expected to undergo a late invasive strategy. Nevertheless, such pretreatment may be considered in patients without a high bleeding risk (Class of Recommendation, IIb; Level of Evidence, C). Despite this ambiguity, P2Y12i pretreatment remains a common clinical practice. The present study aimed to evaluate the in-hospital prognostic impact of P2Y12i treatment prior to coronary angiography (CAG) in NSTE-ACS patients undergoing a late invasive strategy (CAG > 24 h after hospital admission). Methods: A retrospective analysis was conducted on NSTE-ACS patients undergoing a late invasive strategy included in the Portuguese Registry on Acute Coronary Syndromes between 2010 and 2023. The primary endpoint was a composite of in-hospital events, including all-cause mortality, non-fatal re-infarction, non-fatal stroke, and heart failure (HF). Secondary endpoints included the individual components of the primary endpoint and major bleeding (BARC types 3 and 4). Results: A total of 3776 patients were included (mean age, 66 ± 12 yrs; 29% female), of whom 1530 (41%) received P2Y12i pretreatment (group 1). Group 1 had a lower prevalence of prior myocardial infarction (16% vs. 21%) and prior percutaneous coronary intervention (12% vs. 15%) (both p ≤ 0.001). Although obstructive coronary artery disease was more frequent in group 1 (84% vs. 77%, p < 0.001), the presence of multivessel disease did not differ (52% vs. 52%, p = 0.667). Considering in-hospital antithrombotic therapy, group 1 had higher prescriptions of clopidogrel (68% vs. 56%), aspirin (99% vs. 81%), unfractionated heparin (21% vs. 8%), and enoxaparin (80% vs. 56%) (all p < 0.001). There was no significant difference in the primary composite endpoint between groups (9% vs. 9%, p = 0.906). Similarly, the secondary endpoints of all-cause mortality (0.6% vs. 0.7%), re-infarction (1.3% vs. 0.7%), stroke (0.7% vs. 0.4%), and HF (7% vs. 8%) did not differ significantly between groups (all p > 0.05). Nevertheless, group 1 exhibited higher rates of major bleeding (0.8 vs. 0.2%, OR 3.48, CI 95% 1.22–9.89, p = 0.013). Conclusions: Pretreatment with a P2Y12i in NSTE-ACS patients undergoing a late invasive strategy was not associated with reduction in the primary endpoint, although it was associated with higher rates of major bleeding.eng
dc.identifier.citationVazão, A.; Miguel Gonçalves, C.; Martins, A.; Ferreira Carvalho, M.; Cabral, M.; Graça Santos, L.; Pernencar, S.; Filipe Carvalho, J.; Morais, J.; on behalf of the Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators. P2Y12 Inhibitor Pretreatment in Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing a Late Invasive Strategy—A Portuguese Multicenter Nationwide Registry Analysis. Biomedicines 2025, 13, 2212. https://doi.org/10.3390/biomedicines13092212
dc.identifier.doi10.3390/biomedicines13092212
dc.identifier.issn2227-9059
dc.identifier.urihttp://hdl.handle.net/10400.8/14647
dc.language.isoeng
dc.peerreviewedyes
dc.publisherMDPI
dc.relation.hasversionhttps://www.mdpi.com/2227-9059/13/9/2212
dc.relation.ispartofBiomedicines
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectAntithrombotic therapy
dc.subjectLate invasive strategy
dc.subjectPretreatment
dc.subjectNSTE-ACS
dc.subjectP2Y12 inhibitor
dc.titleP2Y12 Inhibitor Pretreatment in Non-ST-Segment Elevation Acute Coronary Syndromes Undergoing a Late Invasive Strategy—A Portuguese Multicenter Nationwide Registry Analysiseng
dc.typejournal article
dspace.entity.typePublication
oaire.citation.issue9
oaire.citation.titleBiomedicines
oaire.citation.volume13
oaire.versionhttp://purl.org/coar/version/c_970fb48d4fbd8a85
person.familyNameMorais
person.givenNameJoão
person.identifier.ciencia-id3614-652A-118E
person.identifier.orcid0000-0003-3406-2878
relation.isAuthorOfPublication3bc0f910-a460-461f-863a-1ca701ee597f
relation.isAuthorOfPublication.latestForDiscovery3bc0f910-a460-461f-863a-1ca701ee597f

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