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P2Y12 inhibitor loading dose before catheterization in ST-segment elevation myocardial infarction: Is this the best
João Pedro Moura Guedes1, Nuno Marques2, Pedro Azevedo1
1Centro Hospitalar Universitário do Algarve, Faro, Portugal; Algarve Biomedical Center, Faro, Portugal; Registo Nacional de Síndromes Coronárias Agudas, Sociedade Portuguesa de Cardiologia, Lisboa, Portugal.
Insights
Administering P2Y12 inhibitor loading doses before percutaneous coronary intervention (PCI) in STEMI patients increased bleeding risk without improving major adverse events. This strategy warrants reevaluation for optimal patient outcomes.
Area of Science:
- Cardiology
- Clinical Trials
- Pharmacology
Background:
- Dual antiplatelet therapy is crucial for ST-segment elevation myocardial infarction (STEMI).
- The optimal timing for P2Y12 inhibitor loading dose (LD) administration remains debated.
- Current practices vary regarding LD administration before versus during/after primary percutaneous coronary intervention (PCI).
Purpose of the Study:
- To characterize P2Y12 inhibitor LD administration practices in Portugal for STEMI patients.
- To assess the prognostic impact of administering P2Y12 inhibitor LD before PCI versus during or after PCI.
Main Methods:
- Multicenter retrospective study using the Portuguese National Registry on Acute Coronary Syndromes.
- Included 4123 STEMI patients who underwent PCI between October 2010 and September 2017.
- Patients were grouped into: LD before PCI (LD-PRE) and LD during or after PCI (LD-CATH).
Main Results:
- 66.3% of patients received LD-PRE, while 32.4% received LD-CATH.
- Prehospital P2Y12 inhibitor LD was linked to increased bleeding risk (composite endpoint, Hb drop >2g/dl) and reinfarction.
- No significant differences were observed in major adverse events (MAE) or in-hospital mortality between the groups.
Conclusions:
- Prehospital P2Y12 inhibitor LD in STEMI patients is associated with higher bleeding risk.
- The observed increase in bleeding complications questions the benefit of this prehospital strategy.
- No improvement in mortality or MAE suggests reconsidering prehospital LD administration timing.
Introduction And Objectives:
In ST-segment elevation myocardial infarction (STEMI) the benefit of dual antiplatelet therapy is unequivocal, but the optimal time to administer the loading dose (LD) of a P2Y12 inhibitor is the subject of debate and disagreement. The main aim of this study was characterize current practice in Portugal and to assess the prognostic impact of P2Y12 inhibitor LD administration strategy, before versus during or after primary percutaneous coronary intervention (PCI).
Methods:
This multicenter retrospective study based on the Portuguese National Registry on Acute Coronary Syndromes included patients with STEMI and PCI performed between October 1, 2010 and September 19, 2017. Two groups were established: LD before PCI (LD-PRE) and LD during or after PCI (LD-CATH).
Results:
A total of 4123 patients were included, 66.3% in the LD-PRE group and 32.4% in the LD-CATH group. Prehospital use of a P2Y12 inhibitor was a predictor of the composite bleeding endpoint (major bleeding, need for transfusion or hemoglobin [Hb] drop >2g/dl), Hb drop >2g/dl and reinfarction. There were no differences between groups in major adverse events (MAE) (in-hospital mortality, reinfarction and stroke) or in-hospital mortality.
Conclusions:
Prehospital use of a P2Y12 inhibitor was associated with an increased risk of bleeding, predicting the composite bleeding outcome and Hb drop >2g/dl, with no differences in mortality or MAE, calling into question the benefit of this strategy.
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