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OUTCOMES OF PRE-LOADING VS IN-LAB LOADING WITH PRASUGREL AND TICAGRELOR IN PATIENTS WITH ACUTE CORONARY SYNDROMES (ACS) UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI)
131 JACC March 21, 2017 Volume 69, Issue 11
Acute and Stable Ischemic Heart Disease OUTCOMES OF PRE-LOADING VS IN-LAB LOADING WITH PRASUGREL AND TICAGRELOR IN PATIENTS WITH ACUTE CORONARY SYNDROMES (ACS) UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI) Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1166-339 Authors: Prasanna Venkataraman, Nick Andrianopoulos, Andrew Teh, Louise Roberts, Stephen Duffy, Angela Brennan, Andrew Ajani, David Clark, Martin Sebastian, Christopher Reid, Melanie Freeman, Melbourne Intervention Group, Melbourne, Australia, Box Hill Hospital, Melbourne, Australia Background: There is uncertainty as to the optimal timing to load patients with P2Y12 inhibitors in ACS, with conflicting advice between American and European guidelines. We evaluated the short-term outcomes and safety of pre-lab versus in-lab loading with the novel P2Y12 inhibitors in patients undergoing PCI for ACS. Methods: We analysed data from 2,887 consecutive patients from a large multicentre Australian registry between 2011 and 2013 who received either prasugrel or ticagrelor. Patients who were intubated, received clopidogrel or thrombolysis were excluded. Clinical and procedural characteristics and in-hospital and 30-day outcomes were compared between the two groups.
Results: Those pre-loaded were more likely to have hypertension, smoking, family history of CAD and prior MI. 1.5% of pre-loaded patients subsequently required inpatient CABG. Those loaded in-lab were more likely to present with cardiogenic shock and STEMI, have single vessel disease and receive GPIIb/IIIa inhibitors. Short-term outcomes were comparable in both groups with no differences in death, peri-procedural AMI, MACE or unplanned revascularization.
In-hospital MACE% 30-day MACE% Bleeding complications% 30-day new bleeding event%
Pre-load n=847 4.1 5.1 1.4 9.9
In-lab load n=2,042 3.0 4.2 2.5 5.0
P Value 0.14 0.28 0.08 0.001
Conclusions: In those ACS patients undergoing PCI and pre-loading with novel P2Y12 inhibitors there were increased rate of 30-day bleeding, with the potential to delay CABG. Pre load with P2Y2 inhibitors did not improve short-term ischaemic outcomes.
Acute and Stable Ischemic Heart Disease OUTCOMES OF PRE-LOADING VS IN-LAB LOADING WITH PRASUGREL AND TICAGRELOR IN PATIENTS WITH ACUTE CORONARY SYNDROMES (ACS) UNDERGOING PERCUTANEOUS CORONARY INTERVENTION (PCI) Poster Contributions Poster Hall, Hall C Friday, March 17, 2017, 3:45 p.m.-4:30 p.m. Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical Presentation Number: 1166-339 Authors: Prasanna Venkataraman, Nick Andrianopoulos, Andrew Teh, Louise Roberts, Stephen Duffy, Angela Brennan, Andrew Ajani, David Clark, Martin Sebastian, Christopher Reid, Melanie Freeman, Melbourne Intervention Group, Melbourne, Australia, Box Hill Hospital, Melbourne, Australia Background: There is uncertainty as to the optimal timing to load patients with P2Y12 inhibitors in ACS, with conflicting advice between American and European guidelines. We evaluated the short-term outcomes and safety of pre-lab versus in-lab loading with the novel P2Y12 inhibitors in patients undergoing PCI for ACS. Methods: We analysed data from 2,887 consecutive patients from a large multicentre Australian registry between 2011 and 2013 who received either prasugrel or ticagrelor. Patients who were intubated, received clopidogrel or thrombolysis were excluded. Clinical and procedural characteristics and in-hospital and 30-day outcomes were compared between the two groups.
Results: Those pre-loaded were more likely to have hypertension, smoking, family history of CAD and prior MI. 1.5% of pre-loaded patients subsequently required inpatient CABG. Those loaded in-lab were more likely to present with cardiogenic shock and STEMI, have single vessel disease and receive GPIIb/IIIa inhibitors. Short-term outcomes were comparable in both groups with no differences in death, peri-procedural AMI, MACE or unplanned revascularization.
In-hospital MACE% 30-day MACE% Bleeding complications% 30-day new bleeding event%
Pre-load n=847 4.1 5.1 1.4 9.9
In-lab load n=2,042 3.0 4.2 2.5 5.0
P Value 0.14 0.28 0.08 0.001
Conclusions: In those ACS patients undergoing PCI and pre-loading with novel P2Y12 inhibitors there were increased rate of 30-day bleeding, with the potential to delay CABG. Pre load with P2Y2 inhibitors did not improve short-term ischaemic outcomes.