• J Invasive Cardiol · Sep 2018

    Multicenter Study Observational Study

    Safety of Percutaneous Coronary Intervention Without P2Y12 Inhibitor Pretreatment From a Cohort of Unselected Patients.

    • Benoit Lattuca, David Belardi, Christophe Demattei, Laurent Schmutz, Luc Cornillet, Bertrand Ledermann, Jean-Christophe Macia, Anaïs Iemmi, Richard Gervasoni, François Roubille, Thien Tri Cung, Pierre Robert, Patrick Messner-Pellenc, Florence Leclercq, and Guillaume Cayla.
    • Cardiology Department, Nîmes University Hospital, Place Pr Debré, 30029 Nîmes, Cedex, France. cayla.guillaume@gmail.com.
    • J Invasive Cardiol. 2018 Sep 1; 30 (9): 348-354.

    ObjectivesRecent studies have challenged systematic pretreatment with a P2Y12 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" P2Y12 inhibitor loading dose, by evaluating ischemic and bleeding complications in unselected patients.MethodsConsecutive patients admitted for elective PCI or NSTEMI were included in this two-center, prospective, observational study, and received a P2Y12 inhibitor after coronary angiography when PCI was decided. The primary composite endpoint was first occurrence of cardiovascular death, myocardial infarction, stroke, urgent revascularization, or use of bail-out glycoprotein IIb/IIIa inhibitors at 30 days after PCI. Stent thrombosis and bleeding criteria (Bleeding Academic Research Consortium [BARC]) were evaluated.ResultsAmong 299 included patients, a total of 188 were admitted for elective PCI and 111 for NSTEMI. The incidence of the primary endpoint was 8.5% (95% confidence interval [CI], 5.7-12.4). No definite stent thrombosis occurred. Three independent predictive factors were associated with the primary endpoint: NSTEMI setting (odds ratio [OR], 5.61; 95% CI, 1.75-17.98), thrombotic coronary lesion (OR, 4.26; 95% CI, 1.45-12.54), and longer procedure duration (OR, 1.06; 95% CI, 1.03-1.09). Clinically relevant bleedings (BARC 2, 3, or 5) occurred in 5.4% of patients.ConclusionsIn an unselected population admitted for elective PCI or NSTEMI in real-world clinical practice, administration of a P2Y12 inhibitor only after coronary angiography is associated with a low rate of ischemic and bleeding events at 30 days.

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