Pretreatment With P2Y12 Inhibitors in Patients With Chronic Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Report From the Swedish Coronary Angiography and Angioplasty Registry

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Pretreatment With P2Y12 Inhibitors in Patients With Chronic Coronary Syndrome Undergoing Percutaneous Coronary Intervention : A Report From the Swedish Coronary Angiography and Angioplasty Registry

Jurga, Juliane (author): Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden

Szummer, Karolina Elizabeth (author): Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Huddinge, Sweden,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden

Lewinter, Christian (author): Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, C.L., L.M., Stockholm, Solna, Sweden,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden

Mellbin, Linda (author): Karolinska Institutet,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden

Götberg, Matthias (author): Department of Cardiology, Lund University Hospital, Skåne, Sweden,Lund Univ Hosp, Sweden

Zwackman, Sammy (author): Linköpings universitet,Avdelningen för diagnostik och specialistmedicin,Medicinska fakulteten,Region Östergötland, Kardiologiska kliniken US

Nilsson, Johan (author): Umeå universitet,Kardiologi,Department of Cardiology, Umeå University and Umeå University Hospital,Umea Univ, Sweden; Umea Univ Hosp, Sweden

Völz, Sebastian, 1980 (author): Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine

Erlinge, David (author): Department of Cardiology, Lund University Hospital, Skåne, Sweden,Lund Univ Hosp, Sweden

Persson, Jonas (author): Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden,Danderyd Hosp, Sweden

Omerovic, Elmir, 1968 (author): Gothenburg University,Göteborgs universitet,Wallenberglaboratoriet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Wallenberg Laboratory,Institute of Medicine, Department of Molecular and Clinical Medicine

Jernberg, Tomas (author): Karolinska Institutet,Danderyd Hosp, Sweden

Venetsanos, Dimitrios (author): Department of Cardiology, Karolinska Institutet and Karolinska University Hospital, C.L., L.M., Stockholm, Solna, Sweden,Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden

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NLM (Medline), 2021
2021
English.
In: Circulation. Cardiovascular Interventions. - : NLM (Medline). - 1941-7640 .- 1941-7632. ; 14:11, s. 1086-1093

Related links:: https://urn.kb.se/re...; show more...; https://doi.org/10.1...; http://kipublication...; https://urn.kb.se/re...; https://gup.ub.gu.se...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

BACKGROUND: In patients with chronic coronary syndrome undergoing percutaneous coronary intervention, the optimal timing of P2Y12 inhibitors' administration is uncertain. We compared pretreatment versus treatment in the catheterization laboratory (In-Cathlab) in a real-world population.METHODS: In Swedish Coronary Angiography and Angioplasty Registry, all patients with chronic coronary syndrome undergoing coronary angiography and ad hoc percutaneous coronary intervention, between 2006 and 2017 were identified. Pretreatment was defined as P2Y12 inhibitor administration before coronary angiography, outside the catheterization laboratory. Outcomes were net adverse clinical events including death, myocardial infarction, stroke, or bleeding within 30 days of the index procedure and in-hospital bleeding.RESULTS: We included 26 814 patients, 8237 in the In-Cathlab, and 18 577 in the pretreatment group. In-Cathlab treatment compared with pretreatment was associated with lower risk for net adverse clinical event (4.2 versus 5.1%, adjusted hazard ratio 0.79 [0.63-0.99]), bleeding (2.3 versus 2.6%, adjusted hazard ratio, 0.76 [0.57-1.01]). and in-hospital bleeding (1.9 versus 2.1%, adjusted odds ratio, 0.70 [0.51-0.96]). The risk for death, myocardial infarction, or stroke did not significantly differ between the groups. Among the In-Cathlab treated patients, 41% received ticagrelor or prasugrel and 59% clopidogrel. Treatment with ticagrelor or prasugrel was associated with higher risk for net adverse clinical events (5.4% versus 3.4%, adjusted hazard ratio, 1.66 [1.12-2.48]), bleeding (3.4 versus 1.6%, adjusted hazard ratio, 2.14 [1.34-3.42]), and in-hospital bleeding (2.9 versus 1.2%, adjusted odds ratio, 2.24 [1.29-3.90]) but similar risk for death, myocardial infarction, or stroke, compared with clopidogrel.CONCLUSIONS: In patients with chronic coronary syndrome undergoing coronary angiography and ad hoc percutaneous coronary intervention, pretreatment with P2Y12 inhibitors, before arrival to the catheterization laboratory, was not associated with improved clinical outcomes but was associated with increased risk for bleeding. Our data support clopidogrel administration in the catheterization laboratory as the standard of care. Graphic Abstract: A graphic abstract is available for this article.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

angioplasty
clopidogrel
odds ratio
percutaneous coronary intervention
ticagrelor

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By the author/editor: Jurga, Juliane; Szummer, Karolin ...; Lewinter, Christ ...; Mellbin, Linda; Götberg, Matthia ...; Zwackman, Sammy; show more...; Nilsson, Johan; Völz, Sebastian, ...; Erlinge, David; Persson, Jonas; Omerovic, Elmir, ...; Jernberg, Tomas; Venetsanos, Dimi ...; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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By the university: Umeå University; Karolinska Institutet; Linköping University; University of Gothenburg

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