Study challenges routine DAPT preloading before PCI for ACS :- Medznat
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Does DAPT preloading before PCI improve ACS outcomes?

Percutaneous coronary intervention Percutaneous coronary intervention
Percutaneous coronary intervention Percutaneous coronary intervention

What's new?

DAPT administration prior to PCI is frequently practiced in ACS patients. But, it is not independently linked to reductions in stent thrombosis, MACE, or in-hospital mortality.

An Australian study has cast doubt on the clinical benefits of routinely administering dual antiplatelet therapy (DAPT) before percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). Despite widespread use, DAPT preloading—administering aspirin plus a P2Y12 inhibitor prior to PCI—was not found to independently minimize the risk of major complications or mortality when adjusted for patient differences.

Researchers analyzed data from 42,453 consecutive ACS-related PCI procedures recorded in the Victorian Cardiac Outcomes Registry. Volunteers were grouped on the basis of whether they were treated with DAPT before PCI, single antiplatelet therapy, or no antiplatelet therapy. Of all patients, 33,520 (79%) were either preloaded or already receiving DAPT prior to PCI. These individuals were generally younger (average age 63.9 vs. 65.1 years, p < 0.001) and had fewer comorbid conditions as opposed to those not on DAPT.

Initial, unadjusted analysis revealed more favorable outcomes in the DAPT group like lower in-hospital mortality, reduced 30-day cardiovascular mortality, lower rates of 30-day major adverse cardiovascular events (MACE), and less in-hospital major bleeding (Table 1):

 

However, once researchers adjusted for differences in baseline characteristics and clinical variables, the advantages of DAPT preloading disappeared. In terms of adjusted in-hospital or 30-day all-cause mortality, MACE, or stent thrombosis, there was no prominent difference between the groups.

Despite its routine use, DAPT before PCI in ACS patients does not independently improve in-hospital or short-term cardiovascular outcomes once differences in patient profiles are considered. The study underscores the need for further trials to clarify the true role of preloading and guide more targeted antiplatelet strategies.

Source:

Catheterization and Cardiovascular Interventions

Article:

Dual Antiplatelet Therapy Prior to Percutaneous Coronary Intervention for Acute Coronary Syndrome: Prevalence and Outcomes in Contemporary Practice

Authors:

Shi Hui Goh et al.

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