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🧠 Historical practice:

Pre-load clopidogrel (or ticagrelor) before cath.

Rationale: reduce thrombotic burden prior to PCI.

🧪 New Data:

Large observational study: 100k+ NSTEMI patients.

No benefit in MI or death with pretreatment.

Longer LOS, delayed CABG in pre-treated patients.

🧩 Clinical Takeaway:

Defer P2Y12 until coronary anatomy is known — especially if CABG is on the table.

If PCI is clearly planned and delay expected — preloading may still be reasonable.