Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes in contemporaneous clinical practice

Hugo Costa; Miguel Espírito-Santo; Raquel Fernandes; João Bispo; João Guedes; Pedro Azevedo; Daniela Carvalho; Hugo Vinhas; Rui Baptista Gonçalves; Jorge Mimoso; Portuguese Registry of Acute Coronary Syndromes (ProACS)

doi:10.1016/j.hjc.2023.11.003

Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes in contemporaneous clinical practice

Hellenic J Cardiol. 2023 Nov 11:S1109-9666(23)00222-1. doi: 10.1016/j.hjc.2023.11.003. Online ahead of print.

Affiliations

¹ Algarve University and Hospital Center, Faro, Algarve, Portugal. Electronic address: hugoalexcosta@sapo.pt.
² Algarve University and Hospital Center, Faro, Algarve, Portugal.
³ School of Medicine, University of Liverpool, Liverpool, UK.
⁴ Portuguese Cardiology Society (SPC), Portugal.

PMID: 37956770
DOI: 10.1016/j.hjc.2023.11.003

Abstract

Background: Pretreatment antithrombotic strategies in non-ST elevation acute coronary syndromes (NSTE-ACS) during hospitalization is still a matter of contention within the cardiology community. Our aim was to analyze in-hospital and one-year follow-up outcomes of patients with NSTE-ACS pretreated with dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT).

Methods: A retrospective study was carried out with NSTE-ACS patients planned to undergo an invasive strategy and were included in the Portuguese Registry of ACS between 2018-2021. A composite primary outcome (in-hospital re-infarction, stroke, heart failure, hemorrhage, death) was compared regarding antiplatelet strategy (DAPT versus SAPT). Secondary outcomes were defined as one-year all-cause mortality and one-year cardiovascular rehospitalization.

Results: A total of 1469 patients were included, with a mean age of 66±12 years and 73.9% were male. DAPT regime was used in 38.2% and SAPT in 61.8% of patients. NSTE myocardial infarction was the most frequent presentation (88.5%). Revascularization after 24h occurred in 44.8% patients (63% of these after 48h). Enoxaparin was the anticoagulant more frequently used (45.1%). The primary outcome was more frequently observed in the SAPT group (10.4%, p=0.033), mainly driven by more ischemic events. Time until revascularization > 48h and SAPT regime were independent predictors of the primary outcome (OR 1.66, p=0.036 and OR 2.03, p=0.008, respectively).

Conclusion: NSTE-ACS patients pretreated with SAPT had worse in-hospital outcomes. This difference can be probably explained by a delay in time until revascularization. Pretreatment DAPT strategy and crossover between heparins is still frequently used in clinical practice.

Keywords: Anticoagulation; Antiplatelet strategy; DAPT; NSTE-ACS; Pretreatment; SAPT.