Optimal timing of initiation of oral P2Y12-receptor antagonist therapy in patients with non-ST elevation acute coronary syndromes. Lessons learnt from the ACCOAST-trial.
The optimal time-point of the initiation of P2Y12 antagonist therapy in patients with non-ST elevation acute coronary syndromes (NTSE-ACS) is still a matter of debate. European guidelines recommend P2Y12 as soon as possible after first medical contact. However, the only trial which compared the two strategies did not demonstrate any benefit of pre-treatment with prasugrel before angiography compared to starting therapy after angiography and just prior to percutaneous coronary intervention (PCI). This paper summarizes the results of pharmacodynamic and previous studies, and gives recommendations for the initiation of P2Y12 antagonist therapy in NSTE-ACS in different clinical situations.
Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Germany zeymeru@klilu.de.
Uwe
U
Zeymer
Centre Hospitalier Universitaire Pitié-Salpêtrière, France.
Gilles
G
Montalescot
Azienda Ospedaliero-Universitaria, Italy.
Diego
D
Ardissino
Azienda Ospedaliero, Italy.
Leonardo
L
Bolognese
Department of Medicine, Division of Cardiology, Nykoebing F Hospital, Denmark.
Peter
P
Clemmensen
Centre Hospitalier Universitaire Pitié-Salpêtrière, France.
Jean-Philippe
JP
Collet
University Hospital La Paz, Spain.
Jose
J
Lopez-Sendon
Cardiology Department at the Third Faculty of Medicine, Charles University and University Hospital, Kralovske Vinohrady, Czech Republic.
Petr
P
Widimsky
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000284:Administration, Oral; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D017410:Practice Guidelines as Topic; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage* / Q000627:therapeutic use; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000627:therapeutic use; D016896:Treatment Outcome
D058921:Purinergic P2Y Receptor Antagonists; D000068799:Prasugrel Hydrochloride
Non ST elevation myocardial infarction; P2Y12 antagonists; Pretreatment