Outcomes in Patients with Acute Coronary Syndrome Treated with Percutaneous Coronary Intervention and Potent P2Y12 inhibitor Based Dual Anti-Platelet Therapy

Acute coronary syndromes (ACS) are an important contributor to global mortality and morbidity. The most common treatment for ACS is percutaneous coronary intervention (PCI) in combination with anti-thrombotic therapy. The most commonly prescribed anti-thrombotic regimen for patients who present with ACS is dual antiplatelet therapy (DAPT), consisting of aspirin and a P2Y₁₂ inhibitor. Despite the clinical importance of ACS, it is notable that considerable debate remains regarding the optimal DAPT strategy for these patients. This is particularly evident in the ongoing scientific debate with regard to whether it is better to combine aspirin with ticagrelor or prasugrel (referred to in this thesis as ‘potent P2Y₁₂ inhibitors’) in patients presenting with ACS. This thesis focuses on outcomes in patients presenting with ACS undergoing PCI and treated with potent P2Y₁₂ inhibitor based DAPT regimens and will address three main scientific questions;

1. In patients presenting with ACS and undergoing PCI, is a ticagrelor based DAPT strategy superior to a prasugrel based strategy?

2. In patients presenting with ACS and treated with PCI and potent P2Y₁₂ inhibitor based DAPT, is PCI complexity associated with a higher risk of ischemic and bleeding outcomes?

3. In patients presenting with ACS and undergoing PCI, does PCI complexity impact on the comparative efficacy and safety of ticagrelor and prasugrel based DAPT strategies?

Addressing these three scientific questions may provide insights and help to guide antiplatelet strategies in ACS patients undergoing PCI.