The Coronary Reperfusion Effect and Safety of Prehospital P2Y12 Inhibitor in Primary-PCI STEMI Patients: A Systematic
Yung-Hua Chou1,2, Cheng-Chieh Huang3,4, Chia-Kai Chang3
1Fire Bureau of Changhua County Government, Changhua, Taiwan.
Insights
Prehospital P2Y12 inhibitor administration in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) improves coronary reperfusion and reduces recurrent myocardial infarction (MI) risk. This approach is safe, showing no increased major bleeding events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Early P2Y12 inhibitor administration is standard for ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- The benefit of prehospital versus in-hospital P2Y12 inhibitor administration on coronary reperfusion remains uncertain.
Purpose of the Study:
- To analyze the efficacy and safety of prehospital P2Y12 inhibitor administration compared to in-hospital administration in STEMI patients undergoing primary PCI.
- To evaluate the impact on coronary reperfusion and key clinical outcomes.
Main Methods:
- A systematic meta-analysis of eight studies involving 10,823 patients was conducted.
- Databases searched included PubMed, EMBASE, and Cochrane Library up to June 2023.
- Primary outcomes were pre-PCI TIMI flow grade 2-3 and major bleeding; secondary outcomes included post-PCI TIMI flow, MACE, recurrent MI, and mortality.
Main Results:
- Prehospital P2Y12 inhibitor administration was associated with significantly higher rates of pre-PCI (OR 1.32) and post-PCI TIMI flow grade 2-3 (OR 1.43).
- A significantly lower risk of recurrent myocardial infarction (MI) was observed with prehospital administration (OR 0.69).
- No significant differences were found in major bleeding (OR 1.00), MACE (OR 0.94), or 30-day mortality (OR 0.87).
Conclusions:
- Prehospital P2Y12 inhibitor administration in STEMI patients undergoing primary PCI improves both pre- and post-procedural coronary reperfusion.
- This strategy significantly reduces the risk of recurrent MI without increasing major bleeding complications.
- Prehospital administration represents a safe and effective approach for enhancing outcomes in STEMI patients.
Background:
The concept of early administration of P2Y12 inhibitor in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is widely accepted, but whether prehospital administration results in greater coronary reperfusion remains unclear. Our study aims to analyze the benefit and safety of prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor administration.
Method:
Three databases (PubMed, EMBASE, and Cochrane Library) were searched from database inception to June 2023. We included all types of studies except for conference publications, abstract presentations, reviews, and case reports. The primary outcomes were pre-PCI TIMI flow grade 2-3 (TIMI = Thrombolysis in Myocardial Infarction) and major bleeding. The secondary outcomes included post-PCI TIMI flow grade 2-3, major adverse cardiac events (MACE), recurrent myocardial infarction (MI), and short-term (30-day) mortality.
Result:
Eight individual studies with a total of 10823 patients were included in our meta-analysis. Compared with in-hospital P2Y12 inhibitor, prehospital P2Y12 inhibitor were associated with significantly higher rates of pre-PCI TIMI flow grade 2-3 (OR 1.32, 95% CI: 1.09-1.61, p = 0.005) and post-PCI TIMI flow grade 2-3 (OR 1.43, 95% CI: 1.04-1.97, p = 0.03), and a significantly lower risk of recurrent MI (OR 0.69, 95% CI: 0.49-0.96, p = 0.03). There were no significant difference in the risk of major bleeding (OR 1.00, 95% CI: 0.75-1.32, p = 0.98), MACE (OR 0.94, 95% CI: 0.70-1.25, p = 0.65), or short-term mortality (OR 0.87, 95% CI: 0.50-1.51, p = 0.61).
Conclusion:
Prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor is associated with a significantly higher rate of pre-PCI and post-PCI TIMI flow grade 2-3, a reduced risk of recurrent MI, and no increase in major bleeding in STEMI patients undergoing primary PCI.
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