Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention
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 pretreatment with clopidogrel in patients wi...
| Main Authors: | , , , , , , , , |
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| Format: | Journal Article |
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Blackwell Publishing
2015
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| Online Access: | http://hdl.handle.net/20.500.11937/47581 |
| _version_ | 1848757872069967872 |
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| author | Yudi, M. Eccleston, D. Andrianpoulos, N. Farouque, O. Duffy, S. Brennan, A. Reid, Christopher Clark, D. Ajani, A. |
| author_facet | Yudi, M. Eccleston, D. Andrianpoulos, N. Farouque, O. Duffy, S. Brennan, A. Reid, Christopher Clark, D. Ajani, A. |
| author_sort | Yudi, M. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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 pretreatment with clopidogrel in patients with NSTEACS undergoing percutaneous coronary intervention (PCI). Methods - We analyzed baseline clinical and procedural characteristics of 6,817 patients with NSTEACS who underwent PCI from the Melbourne Interventional Group registry from 2005-2012. Patients were included in the pretreatment group if clopidogrel was administered prior to cardiac catheterisation. We assessed 30-day mortality, myocardial infarction (MI) and major adverse cardiovascular events (MACE). The safety endpoint was in-hospital bleeding. Results - Of the 6,817 patients, only 2,951 (43%) received pretreatment with clopidogrel. Patients in the pretreatment group were more likely to present with unstable angina (70.8% vs. 68.2%, p=0.02) and have a history of myocardial infarction (35.6% vs. 23.6%, p < 0.01) but were less likely to have PCI within 24 hours 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 MACE (3.7% vs. 4.2%, p=0.25). There was no difference in bleeding complications (1.9% vs. 1.9%, p=0.94). Conclusions - Pretreatment with dual antiplatelet therapy in NSTEACS is not routine clinical practice in Australia. Pretreatment appears safe but is not associated with improved short-term clinical outcomes. |
| first_indexed | 2025-11-14T09:34:59Z |
| format | Journal Article |
| id | curtin-20.500.11937-47581 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| last_indexed | 2025-11-14T09:34:59Z |
| publishDate | 2015 |
| publisher | Blackwell Publishing |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-475812017-09-13T14:10:55Z Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention Yudi, M. Eccleston, D. Andrianpoulos, N. Farouque, O. Duffy, S. Brennan, A. Reid, Christopher Clark, D. Ajani, A. 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 pretreatment with clopidogrel in patients with NSTEACS undergoing percutaneous coronary intervention (PCI). Methods - We analyzed baseline clinical and procedural characteristics of 6,817 patients with NSTEACS who underwent PCI from the Melbourne Interventional Group registry from 2005-2012. Patients were included in the pretreatment group if clopidogrel was administered prior to cardiac catheterisation. We assessed 30-day mortality, myocardial infarction (MI) and major adverse cardiovascular events (MACE). The safety endpoint was in-hospital bleeding. Results - Of the 6,817 patients, only 2,951 (43%) received pretreatment with clopidogrel. Patients in the pretreatment group were more likely to present with unstable angina (70.8% vs. 68.2%, p=0.02) and have a history of myocardial infarction (35.6% vs. 23.6%, p < 0.01) but were less likely to have PCI within 24 hours 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 MACE (3.7% vs. 4.2%, p=0.25). There was no difference in bleeding complications (1.9% vs. 1.9%, p=0.94). Conclusions - Pretreatment with dual antiplatelet therapy in NSTEACS is not routine clinical practice in Australia. Pretreatment appears safe but is not associated with improved short-term clinical outcomes. 2015 Journal Article http://hdl.handle.net/20.500.11937/47581 10.1111/imj.12818 Blackwell Publishing restricted |
| spellingShingle | Yudi, M. Eccleston, D. Andrianpoulos, N. Farouque, O. Duffy, S. Brennan, A. Reid, Christopher Clark, D. Ajani, A. Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention |
| title | Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention |
| title_full | Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention |
| title_fullStr | Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention |
| title_full_unstemmed | Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention |
| title_short | Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention |
| title_sort | pretreatment with dual antiplatelet therapy in patients with non-st-segment elevation acute coronary syndromes undergoing percutaneous coronary intervention |
| url | http://hdl.handle.net/20.500.11937/47581 |