English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Zendy Open

Presents the pdf analysis as premium feature

PDF Analysis

Insights

Presents the summarisation as premium feature

Summarisation

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the zaia usage as premium feature

ZAIA

Zendy Tools

Zendy Plus

Presents the access of premium content as premium feature

Premium Content

Background  Despite guideline recommendations, a significant number of patients with non– ST  elevation myocardial infarction ( NSTEMI ) do not receive dual antiplatelet therapy ( DAPT ) before angiography “pretreatment.” While there may be valid clinical reasons to not pretreat, such as concern for bleeding or multivessel disease warranting coronary artery bypass graft surgery, the degree of variability and factors associated with  DAPT  pretreatment are unknown.    Methods and Results  From the multicenter  TRIUMPH  registry, 1632  NSTEMI  patients were not taking  DAPT  on admission and were included in the study cohort. Among the study patients, only 22% patients received  DAPT  pretreatment. A multivariable logistic regression model showed that race other than white or black (odds ratio [ OR]  0.41, 95%  CI  0.21–0.83), hemoglobin level ( OR  1.18, 95%  CI  1.08–1.29), patients’ bleeding risk (assessed with  NCDR  Cath PCI  Bleeding Risk Score) ( OR  0.85, 95%  CI  0.74–0.99), and severe left ventricular dysfunction ( OR  0.3, 95%  CI  0.13–0.65) were the main predictors of pretreatment with  DAPT , whereas likelihood of needing coronary artery bypass graft surgery ( GRACE  prediction model) was not ( OR  1.09, 95%  CI  0.88–1.35). Median ORs were calculated to assess variability of receiving  DAPT  pretreatment across sites after adjustment for patient characteristics. Receiving  DAPT  pretreatment varied substantially across sites (range 0–100%, mean  OR  3.94,  P <0.0001).    Conclusions  While deviating from guideline‐recommended  DAPT  pretreatment in patients with  NSTEMI  was associated with patient factors (eg, bleeding risk), marked variation was present across sites after accounting for patient‐level characteristics. This suggests that site‐level interventions are needed to improve concordance with current guidelines.

Variation in Practice Regarding Pretreatment With Dual Antiplatelet Therapy for Patients With Non– ST Elevation Myocardial Infarction