Impact of antiplatelet pretreatment on stent thrombosis in patients undergoing PCI in real world practice: insight France PCI registry

Abstract Background The optimal timing for initiating P2Y12 inhibitor therapy in patients undergoing percutaneous coronary intervention (PCI) remains controversial. This study aimed to analyze the impact of dual antiplatelet therapy (DAPT) pretreatment on premature stent thrombosis in patients with CCS and NSTEMI treated by PCI. Methods and Results We analyzed data from 53898 PCI procedures (44412 patients) in the "France PCI" registry between 2014 and 2020. Patients were divided into pretreatment (83.2%) and no pretreatment (16.8%) groups. The primary endpoint was the incidence of in-hospital definite stent thrombosis. Pretreatment was associated with a significantly lower incidence of in-hospital stent thrombosis (0.1% vs. 0.4%; OR: 0.35, 95%CI: 0.22 to 0.57). At one year, the pretreatment group showed lower rates of major adverse cardiovascular events (6.6% vs. 7.8%; OR: 0.83, 95%CI: 0.74 to 0.92) and all-cause mortality (4.6% vs. 6.0%; OR: 0.71, 95%CI: 0.63 to 0.80) without significant increase in major bleeding events. Conclusions In this large real-world cohort, DAPT pretreatment was associated with a significant reduction in in-hospital stent thrombosis and improved one-year clinical outcomes without increasing major bleeding risk.cumulative incidence of IST survival free from NACE