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Pretreatment With P2Y12 Inhibitors in ST-Segment Elevation Myocardial Infarction: Insights From the Bern-PCI Registry
Miklos Rohla1, Shirley Xinyu Ye1, Hiroki Shibutani2
1Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
Insights
Immediate P2Y12 inhibitor loading in ST-elevation myocardial infarction (STEMI) did not improve major adverse cardiac or cerebrovascular events (MACCEs). This study found no significant difference in outcomes between immediate and delayed P2Y12 inhibitor treatment in STEMI patients undergoing PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Limited evidence supports immediate P2Y12 inhibitor loading in ST-elevation myocardial infarction (STEMI).
- Optimal timing for P2Y12 inhibitor administration in STEMI patients undergoing percutaneous coronary intervention (PCI) remains unclear.
Purpose of the Study:
- To compare clinical outcomes of STEMI patients receiving immediate versus delayed P2Y12 inhibitor treatment.
- To evaluate the association between P2Y12 inhibitor pretreatment timing and major adverse cardiac or cerebrovascular events (MACCEs).
Main Methods:
- Prospective cohort study using the Bern-PCI registry (2016-2020).
- STEMI patients undergoing PCI were stratified into two groups based on institutional recommendations for P2Y12 inhibitor pretreatment timing.
- Primary endpoint was a composite of MACCEs (all-cause death, recurrent MI, stroke, stent thrombosis) at 30 days.
Main Results:
- No significant difference in MACCE rates between immediate (10.1%) and delayed (8.1%) P2Y12 inhibitor treatment groups (adjusted HR: 0.91; 95% CI: 0.65-1.28; P=0.59).
- Similar MACCE rates observed between patients receiving pretreatment (7.1%) and those not (8.4%) (adjusted HR: 1.17; 95% CI: 0.78-1.74; P=0.45).
- Baseline characteristics were well-balanced, and median P2Y12 loading to angiography time differed by 52 minutes between cohorts.
Conclusions:
- P2Y12 inhibitor pretreatment was not associated with improved 30-day MACCEs in STEMI patients undergoing primary PCI.
- The findings suggest that the timing of P2Y12 inhibitor loading may not significantly impact short-term clinical outcomes in this patient population.
Background:
Evidence to support immediate P2Y12 inhibitor loading in ST-segment elevation myocardial infarction (STEMI) is limited.
Objectives:
This study sought to compare outcomes of STEMI patients receiving immediate or delayed P2Y12 inhibitor treatment.
Methods:
Using data from the prospective Bern-PCI registry between 2016 and 2020, we stratified STEMI patients undergoing percutaneous coronary intervention according to time periods with different institutional recommendations regarding P2Y12 inhibitor pretreatment. In cohort 1 (October 2016-September 2018), immediate P2Y12 inhibitor treatment was recommended. In cohort 2 (October 2018-September 2020), P2Y12 inhibitor treatment was recommended after coronary anatomy was confirmed. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events (MACCEs) defined as all-cause death, recurrent myocardial infarction, stroke, or definite stent thrombosis at 30 days. Sensitivity analysis included only patients in whom these recommendations were followed.
Results:
Cohort 1 included 1,116 patients; pretreatment was actually given in 708 (63.4%). Cohort 2 included 847 patients; pretreatment was withheld in 798 (94.2%). The mean age was 65 ± 13 years, and 24% were female. Baseline characteristics were well-balanced between groups. The median difference for P2Y12 loading to angiography was 52 minutes between cohort 1 and 2 and 100 minutes between patients receiving vs not receiving pretreatment. Rates of MACCEs were similar between cohort 1 and cohort 2 (10.1% vs 8.1%; adjusted HR: 0.91; 95% CI: 0.65-1.28; P = 0.59) and between patients receiving vs not receiving pretreatment (7.1% vs 8.4%; adjusted HR: 1.17; 95% CI: 0.78-1.74; P = 0.45).
Conclusions:
In this cohort study of patients with STEMI undergoing primary percutaneous coronary intervention, P2Y12 inhibitor pretreatment was not associated with improved MACCEs.
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