Key result
In a nationwide Italian registry of ACS patients undergoing PCI, unfractionated heparin was the most used antithrombotic (64.7% in STEMI, 77.5% in NSTE-ACS), with a 36.0% heparin crossover rate.
Observational (n=2,585)
Yes
In contemporary Italian practice, unfractionated heparin remains the most commonly used periprocedural antithrombotic for ACS patients undergoing PCI, though heparin crossover is frequent.
Registry data reveal predominant unfractionated heparin use with frequent crossover in ACS PCI; leaves open optimal periprocedural strategies.
AIMS: In the last decades, several new therapies have emerged for the treatment of acute coronary syndromes (ACS). We sought to describe real-world patterns of use of antithrombotic treatments in the catheterization laboratory for ACS patients undergoing percutaneous coronary interventions (PCI). METHODS: EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units was a nationwide, prospective registry aimed to evaluate antithrombotic strategies employed in ACS patients in Italy. RESULTS: Over a 3-week period, a total of 2585 consecutive ACS patients have been enrolled in 203 cardiac care units across Italy. Among these patients, 1755 underwent PCI (923 with ST-elevation myocardial infarction and 832 with non-ST-elevation ACS). In the catheterization laboratory, unfractioned heparin was the most used antithrombotic drug in both ST-elevation myocardial infarction (64.7%) and non-ST-elevation ACS (77.5%) undergoing PCI and, as aspirin, bivalirudin and glycoprotein IIb/IIIa inhibitors (GPIs) more frequently employed before or during PCI compared with the postprocedural period. Any crossover of heparin therapy occurred in 36.0% of cases, whereas switching from one P2Y12 inhibitor to another occurred in 3.7% of patients. Multivariable analysis yielded several independent predictors of GPIs and of bivalirudin use in the catheterization laboratory, mainly related to clinical presentation, PCI complexity and presence of complications during the procedure. CONCLUSION: In our contemporary, nationwide, all-comers cohort of ACS patients undergoing PCI, antithrombotic therapies were commonly initiated before the catheterization laboratory. In the periprocedural period, the most frequently employed drugs were unfractioned heparin, leading to a high rate of crossover, followed by GPIs and bivalirudin, mainly used during complex PCI. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02015624.
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Luca et al. (2017) conducted an observational in Acute coronary syndromes (n=2,585). Antithrombotic therapies was evaluated on Patterns of use of antithrombotic treatments in the catheterization laboratory. In a nationwide Italian registry of ACS patients undergoing PCI, unfractionated heparin was the most used antithrombotic (64.7% in STEMI, 77.5% in NSTE-ACS), with a 36.0% heparin crossover rate.
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