Impacto del pretratamiento con inhibidores P2Y12 en pacientes con síndromes coronarios agudos sin elevación del ST. Análisis de dos registros multicéntricos

Alan R. Sigal; Mirza Rivero; Mayra Meza; Gerardo Filippa; Gastón Procopio; Camila M. Abud; Sebastián Nani; Martín Odone; Ernesto Duronto; Juan P. Costabel

doi:10.47487/apcyccv.v4i3.322

Authors

Alan R. Sigal Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina. https://orcid.org/0000-0002-2169-2101
Mirza Rivero CEMIC. Buenos Aires, Argentina. https://orcid.org/0009-0007-1668-7221
Mayra Meza CEMIC. Buenos Aires, Argentina. https://orcid.org/0009-0007-3011-9917
Gerardo Filippa CEMEP. Tierra del Fuego, Argentina.
Gastón Procopio Hospital Universitario Fundación Favaloro. Buenos Aires, Argentina. https://orcid.org/0009-0003-1017-7563
Camila M. Abud Hospital Universitario Fundación Favaloro. Buenos Aires, Argentina. https://orcid.org/0009-0006-2507-7452
Sebastián Nani Clínica Olivos. Buenos Aires, Argentina. https://orcid.org/0009-0006-4397-9388
Martín Odone Sanatorio San Lucas. Buenos Aires, Argentina.
Ernesto Duronto Hospital Universitario Fundación Favaloro. Buenos Aires, Argentina. https://orcid.org/0009-0007-0958-5315
Juan P. Costabel Instituto Cardiovascular de Buenos Aires. Buenos Aires, Argentina. https://orcid.org/0000-0003-0073-5739

DOI:

https://doi.org/10.47487/apcyccv.v4i3.322

Keywords:

NSTEMI, Treatment, Clopidogrel

Abstract

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.

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