Author + information
- Christian Dworeck1,
- Inger Haraldsson2,
- Oscar Angeras3,
- Jacob Odenstedt4,
- Dan Ioanes5,
- Petur Petursson6,
- Sebastian Volz7,
- Per Albertsson8,
- Jonas Persson9,
- Sasha Koul10,
- David Erlinge11,
- Truls Råmunddal12 and
- Elmir Omerovic13
- 1Hospital, trollhattan, Sweden
- 2University of Verona, Gothenburg, Sweden
- 3Mayo Clinic Arizona
- 4Sahlgrenska University Hospital, Gothenburg, Sweden
- 5Sahlgrenska Sweden, Viken, Sweden
- 6Sahlgrenska University Hospital, Gothenburg, Sweden
- 7Sahlgrenska University Hospital, Gothenburg, Sweden
- 8University of Gothenburg, Gothenburg, Sweden
- 9Hjartmedicin/Medicinkliniken, Stockholm, Sweden
- 10Hospital Ramón y Cajal
- 11Skane University Hospital, Lund, Sweden
- 12Sahlgrenska university hospital, Göteborg, Sweden
- 13Department of Cardiology, Hisings Backa, Sweden
Patients with NSTEMI are frequently pretreated with P2Y12 receptor antagonist (P2Y12) and other antithrombotic agents in order to increase patency of IRA and decrease ischemic events. However, there is no clear evidence from randomized clinical trials that pretreatment with P2Y12 in myocardial infarction reduces ischemic events and improves prognosis. The aim of this study was to investigate whether pretreatment with P2Y12 improves patency of IRA at the time of PCI.
We used data from the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry). This database contains information about all consecutive PCI procedures that are performed in Sweden at 31 hospitals. We included all procedures performed between 2005 and 2015 in NSTEMI patients with complete data. The patients were divided into the two groups, P2Y12 pretreated and not-pretreated. We used multilevel modeling based on complete–case mixed-effects logistic regression to adjust for hierarchical database due to clustering of observations. Treated segment (IRA) was the primary observational unit while individual patients and hospitals were treated as additional levels of clustering. These variables were used to adjust for differences in patient’s characteristics: age; gender; hypertension; hyperlipidemia; smoking status; diabetes; calendar year, prior myocardial infarction, coronary by-pass surgery and/or PCI; severity of coronary artery disease; pretreatment with ASA, type of P2Y12 agent, clopidogrel, ticagrelor, prasugrel.
The total of 42,104 patients were included in the study of which 40,731 (97%) were pretreated with P2Y12 and 1,373 (3%) were not. Three different P2Y12 were used, clopidogrel (n=33.431, 79%), ticagrelor (n=7,991, 19%) and prasugrel (n=682, 2%). The number of treated segments was 94,373 of which 10,658 (11%) were occluded and 83,715 (89%) were patent prior to PCI. Non-patent IRA was associated with higher risk of death at 30 days (adjusted OR 2.1; 95% CI 1.68 to 2.56; P<0.000). Pretreatment with P2Y12 was not associated with higher probability for patent IRA (adjusted OR 0.91; 95% CI 0.77 to 1.05; P=0.21). We found no difference between clopidogrel, ticagrelor and prasugrel in regard to patency of IRA (P=0.26 for interaction test).
In this observational study, non-patent IRA was associated with higher risk of death at 30-days in patients with NSTEMI. Pretreatment with P2Y12 was not associated with improved patency of IRA.
CORONARY: Acute Myocardial Infarction