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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Pretreatment with P2Y12 inhibitors and outcome in patients with ST-segment elevation myocardial infarction treated by
Olivier Gach1, Astrid Nyssen1, Charles Pirlet1
1Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, University of Liège, CHU Sart Tilman, Liège, Belgium.
Insights
Pretreatment with prasugrel or ticagrelor in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) shows better outcomes than clopidogrel. These P2Y12 inhibitors are well-tolerated alternatives, reducing adverse events in real-world settings.
Area of Science:
- Cardiology
- Pharmacology
- Interventional Cardiology
Background:
- Pre-treatment with P2Y12 inhibitors (clopidogrel, ticagrelor, prasugrel) is common for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- Limited real-world data exist on the comparative effectiveness of these agents when administered prior to PCI.
Purpose of the Study:
- To evaluate the real-world outcomes of STEMI patients treated with primary PCI based on pre-treatment with clopidogrel, prasugrel, or ticagrelor.
- To compare the safety and efficacy of these three P2Y12 inhibitors in a contemporary STEMI population.
Main Methods:
- Retrospective analysis of 760 STEMI patients undergoing primary PCI.
- Patients were stratified into three groups based on pre-treatment with clopidogrel (n=269), prasugrel (n=327), or ticagrelor (n=164).
- Outcomes assessed included major adverse events, death, stent thrombosis, and bleeding at 1 month and 1 year.
Main Results:
- Patients pre-treated with clopidogrel were older; ticagrelor group had less hypertension but more smokers.
- At 1 month, the clopidogrel group experienced significantly more adverse events (11.1%) compared to ticagrelor (7.1%) and prasugrel (5.1%) groups (P=0.025).
- At 1 year, the clopidogrel group showed higher rates of death (19.5%) and trend towards more stent thrombosis, while bleeding rates were similar across all groups.
Conclusions:
- Pre-treatment with prasugrel or ticagrelor is a safe and effective alternative to clopidogrel in STEMI patients undergoing primary PCI.
- These newer P2Y12 inhibitors demonstrate superior outcomes compared to clopidogrel in real-world practice.
- The findings support the use of prasugrel or ticagrelor for improved patient benefit in STEMI management.
Aims:
Preload with clopidogrel, ticagrelor, or prasugrel in the setting of ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) is frequently applied. Limited data are available regarding the outcome impact of pretreatment with these drugs in the real world.
Methods And Results:
The outcome of 760 STEMI patients treated by primary PCI receiving clopidogrel, prasugrel, or ticagrelor (n = 269, 327, 164, respectively) was evaluated. Patients in the clopidogrel group were older, whereas those in the ticagrelor group had less hypertension but were more active smokers. Angiographic characteristics were comparable among the three groups. At 1 month, more events were observed in the clopidogrel group (11.1%) than in the ticagrelor and prasugrel groups (7.1 vs. 5.1%, P = 0.025), whereas the number of events in the ticagrelor and prasugrel groups did not differ. At 1 year, similar differences existed, mainly driven by a higher rate of death (19.5%, P = 0.008) or stent thrombosis (2 vs. 1.3% for ticagrelor, P = 0.132; vs. 0.3% for prasugrel, P = 0.07) in the clopidogrel group. In-hospital and 1-year bleeding rates were similar between groups.
Conclusion:
In real-world practice, pretreatment with prasugrel or ticagrelor in ongoing STEMI treated by primary PCI seems to be a well tolerated alternative strategy compared with clopidogrel but provides superior benefit in terms of outcomes.
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