{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T11:07:02Z","timestamp":1789556822711,"version":"build-2803163510"},"reference-count":28,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:00:00Z","timestamp":1789171200000},"content-version":"unspecified","delay-in-days":73,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/CRA\/25\/23080"],"award-info":[{"award-number":["FS\/CRA\/25\/23080"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/CRTF\/23\/24428"],"award-info":[{"award-number":["FS\/CRTF\/23\/24428"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,7,22]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Dual antiplatelet therapy is indicated in the management of non-ST-elevation acute coronary syndrome (NSTE-ACS) and can be administered before coronary angiography (pre-treatment) or after coronary anatomy is known. Based on clinical trials with rapid access to inpatient coronary angiography, clinical guidelines recommend invasive assessment prior to commencing a second antiplatelet. We aimed to evaluate the impact of a change in clinical policy from routine P2Y\n                      <jats:sub>12<\/jats:sub>\n                      inhibitor pre-treatment to no routine pre-treatment on in-hospital outcomes in a UK healthcare context.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A retrospective observational study of hospitalised NSTE-ACS patients with a planned invasive strategy at a tertiary cardiac centre in Northeast England was conducted. Two cohorts were identified:\n                      <jats:italic>routine pre-treatment<\/jats:italic>\n                      (1 January 2021 to 31 December 2021) and\n                      <jats:italic>no routine pre-treatment<\/jats:italic>\n                      (1 July 2022 to 30 June 2023). Primary endpoints were in-hospital ST-elevation myocardial infarction (STEMI) and actionable bleeding events, reported as propensity score-adjusted ORs (ORs) and 95%\u2009CIs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 2506 NSTE-ACS cases, 1219 presented before and 1287 after the policy change, which was adhered to in most cases (84.2%). Median time from admission to angiography was 3.6\u2009days (IQR 1.9, 5.8). In comparison to a\n                      <jats:italic>routine pre-treatment<\/jats:italic>\n                      strategy, a\n                      <jats:italic>no routine pre-treatment<\/jats:italic>\n                      strategy was associated with greater risk of in-hospital STEMI (1.7% vs 0.4%, adjusted OR 4.40, 95%\u2009CI 1.78 to 13.3), but lower risk of actionable bleeding events (0.2% vs 0.9%, adjusted OR 0.18, 95%\u2009CI 0.03 to 0.70). There was evidence of pre-treatment effect modification by procedural waiting time on in-hospital STEMI incidence (p for interaction=0.026).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      We observed a greater risk of in-hospital STEMI but lower rates of bleeding following the change from a\n                      <jats:italic>routine pre-treatment<\/jats:italic>\n                      to a\n                      <jats:italic>no routine pre-treatment<\/jats:italic>\n                      strategy. UK waiting times for in-patient coronary angiography are typically considerably longer than the trials on which guidance is based, which may impact the risk\/benefit balance in clinical practice.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2026-004269","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T08:30:16Z","timestamp":1789201816000},"page":"e004269","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["P2Y\n                    <sub>12<\/sub>\n                    inhibitor pre-treatment in NSTE-ACS: translating trial evidence into UK clinical practice"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1155-0409","authenticated-orcid":false,"given":"Kerrick","family":"Hesse","sequence":"first","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"},{"name":"Queen Mary University of London William Harvey Research Institute, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Stephens","sequence":"additional","affiliation":[{"name":"York Hospitals NHS Foundation Trust, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A","family":"Batty","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"},{"name":"Hull York Medical School, Hull, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher David","family":"Bayliss","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"Memon","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shu Xian","family":"Loh","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pyotr","family":"Telyuk","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Swanson","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Muir","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Jackson","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Carter","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Sutton","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sethumadhavan","family":"Vijayan","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul D","family":"Williams","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2429-3579","authenticated-orcid":false,"given":"Enoch","family":"Akowuah","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Academic Cardiovascular Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK"},{"name":"Hull York Medical School, University of York, York, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Austin","sequence":"additional","affiliation":[{"name":"Academic 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Available: https:\/\/www.nicor.org.uk [Accessed 22 Oct 2023]."},{"key":"2026091603503517000_13.2.e004269.10","first-page":"19","article-title":"The Myocardial Ischaemia National Audit Project (MINAP)","volume":"6","author":"Wilkinson","year":"2020","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2026091603503517000_13.2.e004269.11","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.009449"},{"key":"2026091603503517000_13.2.e004269.12","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.34322","article-title":"Assessment of Pretreatment With Oral P2Y12 Inhibitors and Cardiovascular and Bleeding Outcomes in Patients With Non-ST Elevation Acute Coronary Syndromes: A Systematic Review and Meta-analysis","volume":"4","author":"Dawson","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026091603503517000_13.2.e004269.13","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.34472","article-title":"Pretreatment in the Setting of Non-ST-Elevated Acute Coronary Syndrome-When It Is Time to Change","volume":"4","author":"Zeitouni","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026091603503517000_13.2.e004269.14","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/S0140-6736(01)05701-4","article-title":"Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study","volume":"358","author":"Mehta","year":"2001","journal-title":"The Lancet"},{"key":"2026091603503517000_13.2.e004269.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010746"},{"key":"2026091603503517000_13.2.e004269.16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.288.19.2411"},{"key":"2026091603503517000_13.2.e004269.17","doi-asserted-by":"crossref","first-page":"2450","DOI":"10.1016\/j.jacc.2020.08.053","article-title":"Timing of Oral P2Y12 Inhibitor Administration in Patients With Non-ST-Segment Elevation Acute Coronary Syndrome","volume":"76","author":"Tarantini","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026091603503517000_13.2.e004269.18","doi-asserted-by":"crossref","first-page":"1145","DOI":"10.1016\/S0140-6736(09)61738-4","article-title":"Underestimation of the effect of bleeding in clinical trials","volume":"374","author":"Stewart","year":"2009","journal-title":"Lancet"},{"key":"2026091603503517000_13.2.e004269.19","doi-asserted-by":"crossref","first-page":"2460","DOI":"10.1016\/j.jacc.2020.10.010","article-title":"Non-ST-Segment Elevation Acute Coronary Syndrome: The Last Nail in the Coffin of Pre-Treatment","volume":"76","author":"Montalescot","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026091603503517000_13.2.e004269.20","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab277"},{"key":"2026091603503517000_13.2.e004269.21","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.007288","article-title":"To Pretreat or Not to Pretreat (With Oral P2Y12 Antagonists)? 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ESC euroheart report 2025. 2025."},{"key":"2026091603503517000_13.2.e004269.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.08.053"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2026-004269","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T10:50:59Z","timestamp":1789555859000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2026-004269"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,9,12]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/openhrt-2026-004269"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2026-004269","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}