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Systematic review and meta-analysis on the efficacy and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI
Session:
Comunicações Orais - Sessão 11 - Síndromes Coronárias Agudas
Speaker:
João Presume
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Comunicações Orais
FP Number:
---
Authors:
João Presume; Daniel Gomes; Jorge Ferreira; Francisco Albuquerque; Manuel S. Almeida; Miguel Sousa Uva; Carlos Aguiar; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><u><span style="color:black">Introduction:</span></u></strong><span style="color:black"> One of the cornerstones of antithrombotic therapy in patients with ST-segment elevation myocardial infarction (STEMI) is dual antiplatelet therapy (DAPT) with both aspirin and P2Y12 inhibitors, which is associated with better outcomes. Yet, the optimal timing for its initiation is still uncertain. The aim of this study was to perform a systematic review and meta-analysis of evidence on pretreatment with P2Y12 inhibitors in combination with aspirin in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><u><span style="color:black">Methods:</span></u></strong><span style="color:black"> We performed a systematic search of electronic databases Pubmed, CENTRAL, and Scopus until April 2022. Studies were eligible if they were comparing P2Y12 inhibitor upstream administration vs. downstream use in patients with STEMI submitted to PCI. Studies with patients receiving fibrinolysis or medical therapy only were excluded. Outcomes were assessed at the shortest follow-up available.</span> </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><u><span style="color:black">Results:</span></u></strong> <span style="color:black">Out of </span><span style="color:black">2491</span><span style="color:black"> articles, </span><span style="color:black">3</span><span style="color:black"> RCT and 15 non-RCT studies were included, with a total of </span><span style="color:black">79300</span><span style="color:black"> patients (</span><span style="color:black">66.1% </span><span style="color:black">pretreated, 66.0% treated with Clopidogrel). </span><span style="color:black">P</span><span style="color:black">retreatment was associated with reduction in definite stent thrombosis (OR 0.</span><span style="color:black">59</span><span style="color:black"> [0.</span><span style="color:black">37</span><span style="color:black">-0.</span><span style="color:black">94] – figure 1.1</span><span style="color:black">)</span><span style="color:black">, </span><span style="color:black">all-cause death (OR 0.</span><span style="color:black">77</span><span style="color:black"> [0.</span><span style="color:black">60</span><span style="color:black">-</span><span style="color:black">0.97] – figure 1.2</span><span style="color:black">),</span><span style="color:black"> and </span><span style="color:black">cardiogenic shock (</span><span style="color:black">OR</span><span style="color:black"> 0.6</span><span style="color:black">0</span><span style="color:black"> [0.</span><span style="color:black">48</span><span style="color:black">-0.</span><span style="color:black">75]</span><span style="color:black">)</span><span style="color:black">. It was also associated with a lower incidence of TIMI flow <3 pre-PCI (OR 0.78 [0.67-0.92]). However, incidence of recurrent MI was not significantly reduced (OR 0.93 [0.57-1.52]). Regarding safety, pretreatment was not associated with a higher risk of major bleeding events (OR 0.83 [0.75-0.92]). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><u><span style="color:black">Conclusion:</span></u></strong><strong> </strong><span style="color:black">P2Y12 pretreatment was associated with better pre-PCI coronary perfusion, lower incidence of definite stent thrombosis, cardiogenic shock, and, possibly, all-cause mortality with </span>no sign of potential harm encountered.</span></span></p>
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