P2Y₁₂ inhibitor pre-treatment in NST-ACS patients undergoing an early invasive strategy significantly declined after January 2021 compared to before 2021 (P<0.001).
Observational (n=709)
No
Does the 2020 ESC guideline update reduce the use of P2Y12 inhibitor pre-treatment in patients with NST-ACS?
The 2020 ESC guideline updates led to a significant decline in P2Y12 inhibitor pre-treatment among NST-ACS patients undergoing an early invasive strategy, reflecting adherence to new recommendations.
p-value: p=<0.001
Abstract Introduction The use of pre-treatment with P2Y₁₂ inhibitors in non–ST-elevation acute coronary syndrome (NST- ACS) changed in the last few years, evolving from a strategy to be used in all patients to an individualized decision based on the possibility of early intervention. Objective To assess changes in the use of P2Y₁₂ inhibitor pre-treatment among patients with NST- ACS following the 2020 European Society of Cardiology (ESC) guideline updates. Methods This observational study included patients admitted with (NST- ACS) to our center between October 2010 and July 2025, all recorded in a nationwide registry. Patients were analysed according to the P2Y₁₂ inhibitor used and the timing of administration, comparing those admitted before and after January 2021. Differences between groups were assessed with chi-square test and median comparison test for categorical and continuous variables, respectively. Results A total of 709 patients were included: 431 before and 278 after January 2021. An early invasive strategy was performed in 467 patients (65.8%), including 231 (83.1%) after 2021. Significant differences were founded in dyslipidemia (p =0,02); History of atrial fibrillation (p0,001); Cerebrovascular disease (p 0,001); chronic obstructive pulmonary disease (p= 0,032); history of haemorrhages (p=0.009, early invasive strategy use (p 0,001) and ticagrelor use previous ACS (p0,001). Further details are provided in table 1. Loading doses of P2Y₁₂ inhibitors were administered to 422 patients, mostly before 2021 (310; 73.6%). Clopidogrel was used in 228 cases (54%) and ticagrelor in 194 (46%). Before 2021, clopidogrel was the predominant agent (192 patients; 61.9%), while ticagrelor was used in 118 cases (38.6%). After 2021, clopidogrel pre-treatment decreased substantially (36 patients; 29.5%). Significant differences were founded in the use of both P2Y₁₂ inhibitors. Among patients treated after 2021, pre-treatment (either clopidogrel or ticagrelor) was administered to 36.7% of those undergoing an early invasive strategy (61 with ticagrelor) and to 57.4% of those with a deferred invasive approach (versus 70.8% before 2021). Comparing both periods, there was a significant difference between the groups of patients submitted to early invasive strategy (p0,001) but no difference was found between the deferred strategy groups (p =0.602) Conclusions Following the 2020 ESC update, P2Y₁₂ inhibitor pre-treatment markedly declined in our NSTEMI population. However, some overlap between groups may exist, as treatment in the last months of 2020 could already follow new recommendations in some patients. Differences were most evident in the early invasive group, though the absolute number (n=88) remains relevant, indicating a potential area for improvement. In deferred strategies, pre-treatment remained consistent between both periods.
Azevedo et al. (Fri,) conducted a observational in non-ST-elevation acute coronary syndrome (NST-ACS) (n=709). P2Y₁₂ inhibitor pre-treatment vs. Admission before January 2021 was evaluated on Use of P2Y₁₂ inhibitor pre-treatment (p=<0.001). P2Y₁₂ inhibitor pre-treatment in NST-ACS patients undergoing an early invasive strategy significantly declined after January 2021 compared to before 2021 (P<0.001).