Timing of coronary angiography and use of antiplatelet pretreatment in patients with NSTEACS in Spain

Abstract

Introduction and objectives: The optimal timing of coronary angiography in patients admitted with non-ST-segment elevation acute coronary syndrome (NSTEACS) as well as the need for pretreatment are controversial. The main objective of the IMPACT-TIMING-GO registry was to assess the proportion of patients undergoing an early invasive strategy (0-24hours) without dual antiplatelet therapy (no pretreatment strategy) in Spain.

Methods: This observational, prospective, and multicenter study included consecutive patients with NSTEACS who underwent coronary angiography that identified a culprit lesion.

Results: Between April and May 2022, we included 1021 patients diagnosed with NSTEACS, with a mean age of 67±12 years (23.6% women). A total of 87% of the patients were deemed at high risk (elevated troponin; electrocardiogram changes; GRACE score>140) but only 37.8% underwent an early invasive strategy, and 30.3% did not receive pretreatment. Overall, 13.6% of the patients underwent an early invasive strategy without pretreatment, while the most frequent strategy was a deferred angiography under antiplatelet pretreatment (46%). During admission, 9 patients (0.9%) died, while major bleeding occurred in 34 (3.3%).

Conclusions: In Spain, only 13.6% of patients with NSTEACS undergoing coronary angiography received an early invasive strategy without pretreatment. The incidence of cardiovascular and severe bleeding events during admission was low.

Keywords: Acute coronary syndrome; Acute myocardial infarction; Bleeding; Coronariografía precoz; Doble antiagregación plaquetaria; Dual antiplatelet therapy; ESC guidelines; Early invasive strategy; Guía ESC; Hemorragia; Infarto agudo de miocardio; Non–ST-segment elevation acute coronary syndrome; Pretratamiento; Pretreatment; Revascularización; Revascularization; Síndrome coronario agudo; Síndrome coronario agudo sin elevación del segmento ST.