title: Contemporary antithrombotic strategies in patients with acute coronary syndromes managed without revascularization: insights from the EYESHOT study.
abstract: Patients with acute coronary syndromes (ACSs) who are managed without coronary revascularization represent a mixed and understudied population that seems to receive suboptimal pharmacological treatment.
  
  
  
  We 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 = 0.04 and 7.9 vs. 2.7%, P = 0.0009, respectively).
  
  
  
  Almost 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.
  
  
  
  Unique identifier: NCT02015624, http://www.clinicaltrials.gov.
authors.affiliation: Department of Cardiovascular Sciences, European Hospital, Via Portuense 700, Rome, Italy leo.deluca@libero.it centrostudi@anmco.it.
authors.forename: Leonardo
authors.initials: L
authors.lastname: De Luca
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Leonardi
authors.affiliation: Division of Cardiology, Ospedale Civico, Palermo, Italy.
authors.forename: Ignazio Maria
authors.initials: IM
authors.lastname: Smecca
authors.affiliation: Division of Cardiology, Azienda Ospedaliera 'G. Rummo', Benevento, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Formigli
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Donata
authors.initials: D
authors.lastname: Lucci
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.affiliation: Division of Cardiology, Ospedale Loreto Mare, Napoli, Italy.
authors.forename: Bernardino
authors.initials: B
authors.lastname: Tuccillo
authors.affiliation: Department of Cardiology, Ca' Foncello Hospital, Treviso, Italy.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
authors.affiliation: Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy.
authors.forename: Michele Massimo
authors.initials: MM
authors.lastname: Gulizia
authors.affiliation: Cardiology Division, Campo di Marte Hospital, Lucca, Italy.
authors.forename: Francesco Maria
authors.initials: FM
authors.lastname: Bovenzi
authors.affiliation: Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000368:Aged; D003325:Coronary Care Units / Q000706:statistics & numerical data; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007902:Length of Stay / Q000639:trends; D008297:Male; D009204:Myocardial Revascularization; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D005343:Fibrinolytic Agents
keywords: Acute coronary syndromes; Anticoagulant; Antithrombotic therapy; Conservative strategy; Prasugrel; Ticagrelor