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Various studies suggested that pretreatment with P2Y12 receptor antagonist (P2Y12) before percutaneous coronary intervention (PCI) could reduce the rate of ischemic events and mortality in patients with acute coronary syndrome. However, it is not known whether pretreatment with P2Y12 reduce mortality in these patients. We investigated the effect of P2Y12 pretreatment on mortality in consecutive patient treated with PCI.
We used data from the SCAAR registry (Swedish Coronary Angiography and Angioplasty Registry) for the PCI procedures performed in Västra Götaland County in Sweden. The database contains information about all consecutive procedures performed at five PCI centers (∼20% of all SCAAR data). All consecutive procedures performed between 2003 and 2015 for stable angina, UA/NSTEMI and STEMI were included in the analysis. The patients were divided into the two groups, P2Y12 pretreated and not-pretreated. We used instrumental variable analysis (for hidden selection bias) with propensity score to evaluate the effect of pretreatment on mortality at thirty-days and at one-year. Treatment-preference instrumental variable was calendar year and we used a two-stage least squares regression for statistical modelling. The following variables were used to calculate the propensity score: age; gender; hypertension; hyperlipidemia; smoking status; diabetes; arterial access site; severity of coronary artery disease; completeness of revascularization; prior myocardial infarction, coronary by-pass surgery and/or PCI; use of drug-eluting stents; and procedural success.
The total of 17,161 patients were included in the study of which 12,694 (74%) were pretreated with P2Y12 and 4,467 (26%) were not. Three different P2Y12 were used, clopidogrel (n=14670, 85.9%), ticagrelor (n=2446, 13.8%) and prasugrel (n=45, 0.3%) were used. The indication for PCI were: stabile angina (n=3,073), UA/NSTEMI (n=7,602) and STEMI (n=6,486). The number of deaths at thirty-days was 537 (3.3%) and 918 (5.6%) at one-year. We found no difference in model-calculated risk reduction for mortality at thirty-days (1.7%; 95% CI -0.04 to 3.8; P=0.15) and at one-year (1.8%; 95% CI -1.1 to 4.6; P=0.20). There was no interaction between pretreatment and indication for PCI.
In this observational study, pretreatment with P2Y12 receptor antagonist was not associated with lower mortality in patients with stable angina, UA/NSTEMI and STEMI who were treated with PCI.