Pre-treatment with P2Y12 inhibitors in acute myocardial infarction with cardiogenic shock

There are currently no data regarding pre-treatment with P2Y12 inhibitors in patients with acute myocardial infarction complicated with cardiogenic shock (AMI-CS). This study investigates the effectiveness and safety of pre-treatment with P2Y12 inhibitors in patients with AMI-CS.

Using the ACTION-SHOCK cohort, we included consecutive patients hospitalized between 2012 and 2023 with AMI-CS admitted for coronary angiography within 24 h of admission. Pretreatment was defined by the administration before angiography of an oral loading dose of a P2Y12 inhibitor. We evaluated the association between pretreatment and either major adverse cardiovascular events (MACE) or major bleeding at 30 days after admission, using an inverse probability weighting (IPW) approach. MACE was defined by the composite of all-cause death, ischaemic stroke, myocardial infarction, or stent thrombosis. Major bleeding was defined by Bleeding Academic Research Consortium grade 3, 4, or 5. Among the 421 patients with AMI-CS admitted to the catheterization laboratory within 24 h of admission, 224 (53.2%) patients received pre-treatment with a P2Y12 inhibitor. No association between pre-treatment with P2Y12 inhibitor and MACE at 30 days was found [42.1% vs. 38.8%-IPW hazard ratio (wHR): 1.11, 95% CI: 0.82-1.50]. Pre-treatment was associated with an increased risk of major bleeding (42.2% vs. 32.3%-wHR: 1.48, 95% CI: 1.05-2.08). The effect of pre-treatment on MACE or major bleeding at 30 days is consistent across STEMI/NSTEMI patients.

In patients with AMI-CS, pretreatment with a P2Y12 inhibitor oral load was associated with an increased risk of major bleeding without benefit on MACE.