Periprocedural Myocardial Injury in High‐Risk Patients With NSTEMI Pretreated With Ticagrelor for Less or More Than 6 Hours Before PCI

Abstract

We assessed the impact on periprocedural myocardial injury of a ticagrelor loading dose given <6 or >6 hours before percutaneous coronary intervention (PCI) in non-ST-elevation myocardial infarction (NSTEMI) patients at high risk. All consecutive patients pretreated with ticagrelor and undergoing PCI for a high-risk NSTEMI have been included in the present analysis. Propensity-score matching was performed to compare the outcomes between patients pretreated with ticagrelor for >6 hours or ≤6 hours. The primary outcome was the rate of periprocedural myocardial injury after PCI. We also recorded clinical outcomes, including major adverse cardiovascular events and major bleedings at 1 month. A total of 1216 patients with NSTEMI were deemed eligible for the study: 481 received a ticagrelor loading dose ≤6 hours (mean time, 4.3 ± 1.2 h) and 735 >6 hours (16.1 ± 8.4 hours) before PCI. Patients pretreated with ticagrelor for >6 hours presented more risk factors and comorbidities compared to others. In patients pretreated with ticagrelor for >6 hours, the rate of periprocedural myocardial injury was significantly lower compared to the other group, in the overall population (19.6% vs 37.8%; P < .0001) and in the matched cohort of 644 patients (18.9% vs 33.5%; P < .0001). The rate of major adverse cardiovascular events and major bleeding events did not differ between the two groups, in both unmatched and matched populations. The present study suggests that ticagrelor pretreatment reduces periprocedural myocardial injury in high-risk patients with NSTEMI undergoing PCI with expected time intervals >6 hours.

Effect of pretreatment with a P2Y12 inhibitor in patients with non-ST-elevation acute coronary syndrome: a systematic review and network meta-analysis

“…The remaining number of articles was 123. Studies that did not meet the inclusion or exclusion criteria, or had unclear expressions were further eliminated by reading the full text, and 21 articles were obtained (4,5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), including 13 RCTs (4,5,12,14,16,(18)(19)(20)(21)(23)(24)(25)(26) and eight observational studies (11,13,15,17,22,(27)(28)(29). Literature retrieval and screening processes were carried out in accordance with the PRISMA guidelines; the specific process of screening is shown in Figure 1.…”

“…Twenty-one studies with MACCEs were included in the analysis (119,014 patients with NSTE-ACS) (4,5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). The results of the inconsistency test showed that the inconsistency was not significant (I 2 = 4.21, P = 0.239); therefore, the consistency model was used for the analysis.…”

“…Twenty-one studies with 119,014 patients with NSTE-ACS were included in this study (4,5,(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). The general characteristics of the included studies are presented in Table 1.…”