Coronary disease & ACSCohort study
P2Y12 Inhibitor Pretreatment in Non–ST-Segment Elevation Acute Coronary Syndrome
- Retrospective cohort study
- registry-based
- instrumental variable analysis
- hierarchical regression
Authors' conclusion
In a national U.S. registry, we observed significant variability in the use of P2Y12 inhibitor pretreatment among NSTE-ACS patients.
Study context
- Population
- Patients with NSTE-ACS undergoing early invasive strategy (angiography ≤24 h of arrival), NCDR Chest Pain-MI Registry, UScontemporary cohort 2019–2023
- Participants
- 110,148 patients
- Exposure
- P2Y12 inhibitor pretreatment vs no pretreatment
- Pretreatmentn = 17,509
Main finding
As reported in the abstract
Use of P2Y12 inhibitor pretreatment and its variability
- Pretreatment use, 2013Q1 → 2023Q1
- 24.8% → 12.4%
- Pretreatment use, contemporary cohort
- 15.9%
- Range across operators/institutions
- 0%-100%
- Median OR, operator
- 3.74 (95% CI 3.57-3.91)
- Median OR, institution
- 3.63 (95% CI 3.51-3.74)
Observational data: associations, not effects.
Further findings
In-hospital all-cause death · instrumental variable analysis
P = 0.07
Recurrent MI · in-hospital · instrumental variable analysis
P = 0.98
Safety
Major bleeding · in-hospital · instrumental variable analysis
P = 0.98
Length of stay in patients undergoing CABG
P < 0.01
Original publication
P2Y12 Inhibitor Pretreatment in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol. Published 15 November 2024. doi:10.1016/j.jacc.2024.09.1227
Summarised from the published abstract; every number is checked against it