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

Aims: 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. Methods and results: 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). Conclusion: 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. Registration: URL: http://www.clinicaltrials.gov. NCT06316128.