Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16106
Title: Pre-treatment with dual antiplatelet therapy in patients with non-ST-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention.
Austin Authors: Yudi, MB;Eccleston, David;Andrianopoulos, Nick;Farouque, Omar ;Duffy, Stephen J;Brennan, Angela;Reid, Christopher M;Clark, David J ;Ajani, Andrew E
Institutional Author: Melbourne Interventional Group
Affiliation: Austin Health, Heidelberg, Victoria, Australia
Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Melbourne, Victoria, Australia
Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
The University of Melbourne, Parkville, Victoria, Australia
Issue Date: Oct-2016
metadata.dc.date: 2015-10-01
Publication information: Internal Medicine Journal 2015; 45(1): 1032-1037
Abstract: BACKGROUND: Although dual antiplatelet therapy is the standard of care in non-ST-segment elevation acute coronary syndromes (NSTEACS), it remains unclear when a second antiplatelet agent should be initiated. We sought to assess the safety and efficacy of pre-treatment with clopidogrel in patients with NSTEACS undergoing percutaneous coronary intervention (PCI). METHODS: We analysed baseline clinical and procedural characteristics of 6817 patients with NSTEACS who underwent PCI from the Melbourne Interventional Group registry from 2005 to 2012. Patients were included in the pre-treatment group if clopidogrel was administered prior to cardiac catheterisation. We assessed 30-day mortality, myocardial infarction (MI) and major adverse cardiovascular events. The safety endpoint was in-hospital bleeding. RESULTS: Of the 6817 patients, only 2951 (43%) received pre-treatment with clopidogrel. Patients in the pre-treatment group were more likely to present with unstable angina (70.8% vs 68.2%, P = 0.02) and have a history of MI (35.6% vs 23.6%, P < 0.01) but were less likely to have PCI within 24 h of admission (17.2% vs 25.2%, P < 0.01). There was no difference between the groups in 30-day mortality (0.9% vs 1.4%, P = 0.06), MI (2.0% vs 2.2%, P = 0.52) or major adverse cardiovascular event (3.7% vs 4.2%, P = 0.25). There was no difference in bleeding complications (1.9% vs 1.9%, P = 0.94). CONCLUSIONS: Pre-treatment with dual antiplatelet therapy in NSTEACS is not routine clinical practice in Australia. Pre-treatment appears safe but is not associated with improved short-term clinical outcomes.
URI: http://ahro.austin.org.au/austinjspui/handle/1/16106
DOI: 10.1111/imj.12818
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/26013065
Type: Journal Article
Subjects: NSTEACS
PCI
Clopidogrel
Pre-treatement
Appears in Collections:Journal articles

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