Dual Antiplatelet Pretreatment Comparison among Non-ST-Elevation Myocardial Infarction Patients

Abstract

Objectives: To compare the effects of dual antiplatelet pretreatment strategies among non-ST elevation myocardial infarction (NSTEMI) patients referred for an early invasive strategy to tertiary care hospitals. Methodology: This cross-sectional study was conducted at the Department of Cardiology, Liaquat National Hospital, from June 2024 to December 2024. All patients referred for early invasive management and preloaded with dual antiplatelets were categorized into three groups based on their management approach: conservative, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG). Statistical analysis was performed using IBM SPSS Statistics version 27. Mean and standard deviations were calculated for quantitative variables, while frequencies and percentages were reported for qualitative variables. Odds ratios were also computed. Results: A total of 109 NSTEMI patients were included, with a mean age of 63.06 ± 10.28 years; 64.2% were male. The majority had hypertension (75.9%), diabetes (66.2%), and a history of smoking (75.4%). Of the patients, 46.78% received pretreatment with clopidogrel, while 53.22% received ticagrelor. During hospitalization, 44% underwent PCI, 26% underwent CABG, and 29% were managed conservatively. Adverse outcomes included 3 deaths (3.2%), 3 myocardial infarctions (3.2%), 4 strokes (3.7%), 3 definite/probable stent thromboses (3.2%), and 6 major bleeding events (6.54%) as per BARC classification. Conclusion: Pretreatment with P2Y12 receptor antagonists in patients with NSTE-ACS was not associated with improved clinical outcomes but was linked to a higher risk of bleeding. These findings suggest that routine pretreatment should be reconsidered, and that a more individualized strategy based on coronary anatomy and bleeding risk is warranted.