Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 30;4(3):96-101.
doi: 10.47487/apcyccv.v4i3.322. eCollection 2023 Jul-Sep.

[Impact of pretreatment with P2Y12 inhibitors in patients with acute coronary syndromes without ST elevation. Analysis of 2 multicenter registries]

[Article in Spanish]
Alan R Sigal  1 , Mirza Rivero  2 , Mayra Meza  2 , Gerardo Filippa  3 , Gastón Procopio  4 , Camila M Abud  4 , Sebastián Nani  5 , Martín Odone  6 , Ernesto Duronto  4 , Juan P Costabel  1
Affiliations

[Impact of pretreatment with P2Y12 inhibitors in patients with acute coronary syndromes without ST elevation. Analysis of 2 multicenter registries]

[Article in Spanish]
Alan R Sigal et al. Arch Peru Cardiol Cir Cardiovasc. .

Abstract
in English, Spanish

Objectives: To evaluate the rate of use of antiplatelet pretreatment in patients with non-ST elevated acute coronary syndrome (NSTEACS) and its association with adverse events in two Argentine registries.

Materials and methods: We retrospectively analyzed two Argentine acute coronary syndrome (ACS) registries from 2017 and 2022. We explored the incidence of pretreatment and the drug used. We evaluated the relationship between this strategy and a composite clinical outcome of in-hospital events: death + myocardial infarction + stent thrombosis + post-MI angina + transient ischemic event/cerebrovascular event, and with bleeding events (BARC 2 or higher). Subsequently, we performed a multivariate analysis by logistic regression with other clinical variables.

Results: A total of 1297 patients were included; 75.6% were men, 25.6% diabetics, 27.1% smokers, 70.3% hypertensive, and 23.1% had a previous ACS. The mean age was 55.3 years. The mean GRACE score was 113.5, and the CRUSADE was 23.8. 44% of the patients received pretreatment, the majority with clopidogrel (93.5%). Pretreatment was significantly associated with a higher incidence of the composite clinical outcome (10.1% vs. 6.9%) (OR 1,56; IC 95%: 1,06-2,3; p=0,02). Bleeding events were numerically more frequent with pretreatment (8.7% vs. 5.9%) (OR 1,51; IC95%: 0,99 -2,3; p=0,054). In the multivariate analysis, pretreatment was no longer associated with a higher incidence of ischemic outcomes (OR 1,4; IC95%: 0,89-2,3; p=0,13).

Conclusion: Pretreatment was used in almost half of the patients, mainly with clopidogrel, and did not show a reduction in ischemic events in patients with NSTACS.

Objetivos.: Evaluar la tasa de uso de pretratamiento antiagregante en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) y su asociación con eventos adversos en dos registros argentinos.

Materiales y métodos.: Se analizaron retrospectivamente dos registros argentinos de síndromes coronarios agudos (SCA) de 2017 y 2022. Se exploró la incidencia de pretratamiento y el fármaco utilizado y se evaluó la relación entre esta estrategia y un resultado clínico compuesto de eventos intrahospitalarios: muerte + infarto de miocardio + trombosis del stent + angina postinfarto + accidente isquémico transitorio/accidente cerebro vascular más los eventos hemorrágicos (BARC 2 o superior). Posteriormente, se realizó un análisis multivariado por regresión logística con otras variables clínicas.

Resultados.: Se incluyeron 1297 pacientes. El 75,6% eran hombres, 25,6% diabéticos, 27,1% fumadores, 70,3% hipertensos y 23,1% tenían un SCA previo. La edad media era de 55,3 años. La puntuación GRACE media fue de 113,5 y la CRUSADE de 23,8. El 44% de los pacientes recibieron pretratamiento, la mayoría con clopidogrel (93,5%). El pretratamiento se asoció significativamente con una mayor incidencia del resultado clínico compuesto (10,1% vs. 6,9%) (OR 1,56; IC 95%: 1,06-2,3; p=0,02). Los eventos hemorrágicos fueron numéricamente más frecuentes con el pretratamiento (8,7% frente a 5,9%) (OR 1,51; 0,99-2,3; p=0,054). En el análisis multivariado el pretratamiento ya no se asoció con una mayor incidencia de desenlaces isquémicos (OR 1,4; 0,89-2,3; p=0,13) ni hemorrágicos.

Conclusiones.: El pretratamiento se utilizó en casi la mitad de los pacientes, principalmente con clopidogrel, y no mostró una reducción de eventos isquémicos en pacientes con SCASEST de la vida real.

Keywords: Clopidogrel; NSTEMI; Treatment.

PubMed Disclaimer

Conflict of interest statement

Conflictos de interés: Los autores declaran no tener ningún conflicto de interés

Figures

Figura 1
Figura 1. Figura central que resume los hallazgos del trabajo.
See this image and copyright information in PMC

References

    1. Wivviot SD, Antman EA. Clopidogrel Resistance A New Chapter in a Fast-Moving Story. Circulation. 2004;109(25):3064–3067. doi: 10.1161/01.CIR.0000134701.40946.30. - DOI - PubMed
    1. Gurbel PA, Bliden KP, Butler K, Tantry US, Gesheff T, Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease the ONSET/OFFSET study. Circulation. 2009;120(25):2577–2585. doi: 10.1161/CIRCULATIONAHA. - DOI - PubMed
    1. Zhu B, Effron MB, Kulkarni MP, Li YG, Jakubowski JA, Miller DB, et al. The onset of inhibition of platelet aggregation with prasugrel compared with clopidogrel loading doses using gatekeeping analysis of integrated clinical pharmacology data. J Cardiovasc Pharmacol. 2011;57(3):317–324. doi: 10.1097/FJC.0b013e3182073dfb. - DOI - PubMed
    1. Gurbel PA, Bliden KP, Hiatt BL, O Connor CM. Clopidogrel for coronary stenting response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation. 2003;107(23):2908–2913. doi: 10.1161/01.CIR.0000072771.11429.83. - DOI - PubMed
    1. Montalescot G, Bolognese L, Dudek D, Goldstein P, Hamm C, Tanguay JF, et al. Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes. N Engl J Med. 2013;369(11):999–1010. doi: 10.1056/NEJMoa1308075. - DOI - PubMed

Publication types

LinkOut - more resources