Timing of P2Y₁₂ Therapy Initiation in Non–ST-Segment Elevation Acute Coronary Syndromes

Dual antiplatelet therapy with aspirin and a P2Y₁₂ inhibitor is a mainstay of medical therapy for patients with non–ST-segment elevation acute coronary syndrome (NSTE-ACS). But what is the optimal timing for starting therapy? In a multicenter Italian study (DUBIUS; NCT02618837), investigators randomized 1449 patients with NSTE-ACS (unstable angina or non-STE myocardial infarction) who were slated for invasive management to receive a pretreatment strategy with ticagrelor before angiography or no pretreatment, on top of baseline aspirin therapy. Patients in the non-pretreatment group undergoing percutaneous coronary intervention (PCI; 72% of the population) were secondarily randomized to ticagrelor or prasugrel.

The primary endpoint was a comb…