Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: insights from the EYESHOT study

Abstract

AimsPatients with acute coronary syndromes (ACSs) who are managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment. Methods and resultsWe assessed patterns of antithrombotic therapies employed during the hospitalization and in-hospital clinical events of medically managed patients with ACS enrolled in the prospective, multicentre, nationwide EYESHOT (EmploYEd antithrombotic therapies in patients with acute coronary Syndromes HOspitalized in iTalian cardiac care units) registry. Among the 2585 consecutive ACS patients enrolled in EYESHOT, 783 (30.3%) did not receive any revascularization during hospital admission. Of these, 478 (61.0%) underwent coronary angiography (CA), whereas 305 (39.0%) did not. The median GRACE and CRUSADE risk scores were significantly higher among patients who did not undergo CA compared with those who did (180 vs. 145, P , 0.0001 and 50 vs. 33, P , 0.0001, respectively). Antithrombotic therapies employed during hospitalization significantly differ between patients who received CA and those who did not with unfractioned heparin and novel P2Y12 inhibitors more frequently used in the first group, and low-molecular-weight heparins and clopidogrel in the latter group. During the index hospitalization, patients who did not receive CA presented a higher incidence of ischaemic cerebrovascular events and of mortality compared with those who underwent CA (1.6 vs. 0.2%, P ¼ 0.04 and 7.9 vs. 2.7%, P ¼ 0.0009, respectively). ConclusionAlmost one-third of ACS patients are managed without revascularization during the index hospitalization. In this population, a lower use of recommended antiplatelet therapy and worse clinical outcome were observed in those who did not undergo CA when compared with those who did. Clinical Trial RegistrationUnique identifier: NCT02015624, http://www.clinicaltrials.gov.--

The underutilisation of dual antiplatelet therapy in acute coronary syndrome

“…Barely half of these patients were discharged on DAPT despite their higher GRACE risk score when compared to revascularised patients, closely matching the 54% reported in CRUSADE 2004-2005 [5]. A recent Italian registry study showed that at the time of discharge, DAPT was prescribed in 58.8% of medically managed patients [23].…”

Consensus Document ANMCO/ANCE/ARCA/GICR-IACPR/GISE/SICOA: Long-term Antiplatelet Therapy in Patients with Coronary Artery Disease

“…Although there is mutual agreement on the importance of revascularisation in patients with NSTE-ACS, a large proportion of these patients do not benefit from this treatment. In fact, in the Italian EYESHOT registry 42.7% of patients with NSTE-ACS were started on conservative therapy, of which 17.2% did not even receive coronary angiographic examination, while 25.5% were not revascularised following coronary angiography 236 .…”

Monitoring of the Effectiveness of Antiplatelet Therapy in Cardiology Practice

“…прак-тически являющихся «неизученными» [5]. В отличие от пациентов, включенных в программу проспективных клинических исследований, риск клинических событий может быть выше в рутинной практике, и персонали-зированная антиагрегантная терапия может играть большую роль.…”