Timing, Selection, Modulation, and Duration of P2Y12 Inhibitors for Patients With Acute Coronary Syndromes Undergoing PCI

Dual antiplatelet therapy with aspirin and the oral P2Y(12) inhibitor clopidogrel as the cornerstone of treatment for patients with an acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) was firstly established in 2001. Soon thereafter, the newer-generation P2Y(12) inhibitors prasugrel and ticagrelor became commercially available. The clinical management of ACS patients undergoing PCI has evolved significantly in the last 2 decades, with a shift toward more rapid invasive management, broader use of drug-eluting stents, and the increasing recognition that major bleeding due to antiplatelet therapy is detrimental. In this ever-changing scenario, numerous studies have addressed 4 main questions regarding P2Y(12) inhibition in ACS patients undergoing PCI: timing, selection, modulation, and duration. This paper reviews the latest evidence surrounding these topical questions, with a focus on efficacy and safety data, practice guidelines, and residual areas of uncertainty. (c) 2023 by the American College of Cardiology Foundation.

Automated summary

Dual antiplatelet therapy with aspirin and clopidogrel is the standard treatment for ACS patients undergoing PCI, but newer P2Y(12) inhibitors have also been developed. The management of ACS patients undergoing PCI has evolved, with a focus on rapid invasive treatment, drug-eluting stents, and minimizing bleeding risks. This paper reviews the latest evidence on timing, selection, modulation, and duration of P2Y(12) inhibition in ACS patients undergoing PCI.