Acute pharmacologic management of myocardial infarction in patients undergoing percutaneous coronary intervention: insights from the Italian nationwide EYESHOT-2 prospective registry

International guidelines recommend specific antithrombotic strategies for acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). However, real-world practice often diverges. This study aimed to assess antithrombotic therapy use in AMI patients admitted to cardiac care units (CCUs) across Italy.

The EmploYEd Antithrombotic Therapies in Patients with Acute Coronary Syndromes Hospitalized in Italian Cardiac Care Units (EYESHOT-2) registry (NCT06316128) is an Italian nationwide, prospective study evaluating AMI management, focusing primarily on PCI-treated patients. Between 1 and 29 February 2024, 2806 patients were enrolled across 183 Italian CCUs. Percutaneous coronary intervention was performed in 83.5% of cases, while 16.5% received conservative treatment. Patients not undergoing PCI were older, more often female, had more comorbidities, and were more frequently diagnosed with NSTEMI. Pre-treatment with dual antiplatelet therapy before angiography was administered in 58.4% of PCI-treated patients. In the cath lab, most received oral P2Y₁₂ inhibitors post-procedure. In-hospital outcomes favoured PCI, with lower rates of mortality, re-infarction, and major bleeding. Independent predictors of in-hospital bleeding among PCI patients included older age [odds ratio (OR) 1.05, 95% confidence interval (CI) 1.03–1.07, P < 0.0001], prior bleeding (OR 2.38, 95% CI 1.02–5.59, P = 0.046), recent surgery (OR 3.47, 95% CI 1.28–9.42, P = 0.01), Killip class III/IV (OR 1.75, 95% CI 1.00–3.05, P = 0.049), and femoral access (OR 2.85, 95% CI 1.80–4.49, P < 0.0001), while, among patients treated conservatively, included history of anaemia (OR 4.83, 95% CI 2.24–10.41, P < 0.0001) and peripheral vascular disease (OR 2.75, 95% 1.24–6.12, P = 0.01).

This nationwide registry highlights improvements in AMI care in Italy but reveals persistent discrepancies between guideline-recommended and actual practice, underscoring the need for broader adoption of evidence-based strategies.

URL: http://www.clinicaltrials.gov. NCT06316128.