Recent studies have challenged systematic pretreatment with a P2Y₁₂ inhibitor before percutaneous coronary intervention (PCI) in elective and non-ST-segment elevation myocardial infarction (NSTEMI) patients. The aim of this study was to assess outcomes after performing PCI immediately after coronary angiography with an exclusive ‘on-the-table’ P2Y₁₂ inhibitor loading dose, by evaluating ischaemic and bleeding complications in unselected patients.

Consecutive patients admitted for elective PCI or NSTEMI were included in this bicentric, prospective observational study, and received a P2Y₁₂ inhibitor after coronary angiography when PCI was decided. The primary composite endpoint was first occurrence of cardiovascular death, myocardial infarction, stroke, urgent revascularisation or use of bailout glycoprotein IIb/IIIa inhibitors at 30 days after PCI. Stent thrombosis and bleedings (Bleeding Academic Research Consortium [BARC]) criteria were evaluated.

Among 299 included patients, 188 were admitted for elective PCI and 111 for NSTEMI. The incidence of the primary endpoint was 8.5% (95% CI 5.7 to 12.4). No definite stent thrombosis occurred. Three independent predictive factors were associated with the primary endpoint: NSTEMI setting (OR 5.61 (95% CI 1.75 to 17.98), thrombotic coronary lesion (OR 4.26 (95% CI 1.45 to 12.54) and longer procedure duration (OR 1.06 (95% CI 1.03 to 1.09). Clinically relevant bleedings (BARC type 2, 3 or 5) occurred in 5.4% of patients.

In an unselected population admitted for elective PCI or NSTEMI in real-life practice, administration of a P2Y₁₂ inhibitor only after coronary angiography is associated with a low rate of ischaemic and bleeding events at 30 days.