Treatment of STEMI patients with P2Y12 Inhibitor before hospitalization may not improve MACE

This study aimed to compare the outcomes of STEMI patients receiving immediate or delayed P2Y12 inhibitor treatment, as evidence to support immediate P2Y12 inhibitor loading in these cases is limited.

Researchers stratified STEMI patients in the Bern-PCI registry between 2016 and 2020 into two cohorts based on P2Y12 inhibitor pretreatment. In cohort 1 (2016-2018), immediate P2Y12 inhibitor treatment was recommended, while in cohort 2 (2018-2020), it was recommended after confirming coronary anatomy. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events (MACCEs) at 30 days. Sensitivity analysis included only patients who followed these recommendations.

Key summary points from this study are:

• Cohort 1 and Cohort 2 had 1,116 and 847 of mean age 65 ± 13 years, and 24% were female patients, respectively.
• In Cohort 1, pretreatment was given in 708 patients, while in Cohort 2, pretreatment was withheld in 798.
• Between the groups, the baseline characteristics were well-balanced.
• The median difference for P2Y12 loading to angiography was 52 minutes between cohorts 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).

They said that in this cohort study of patients with STEMI undergoing primary percutaneous coronary intervention, we found that P2Y12 inhibitor pretreatment was not associated with improved MACCEs.

Reference:

Rohla, M, Ye, S, Shibutani, H. et al. Pretreatment With P2Y12 Inhibitors in ST-Segment Elevation Myocardial Infarction: Insights From the Bern-PCI Registry. J Am Coll Cardiol Intv. 2024 Jan, 17 (1) 17–28.