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Pre-treatment with Unfractionated Heparin alongside aspirin and a P2Y12 inhibitor in ST-Elevation Myocardial Infarction patients undergoing Percutaneous Coronary Intervention
Session:
Comunicações Orais - Sessão 09 - Síndrome coronária aguda 1
Speaker:
Bernardo Manuel Lisboa Resende
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Bernardo Lisboa Resende; Gonçalo Ferraz Costa; Rafaela Fernandes; Tomás M. Carlos; Ana Luísa Silva; Luísa Gomes Rocha; Mafalda Griné; Tatiana Santos; Gonçalo Terleira Batista; Mariana Simões; João Gameiro; Lino Gonçalves
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Background: </strong>Acute ST-Elevation Myocardial Infarction (STEMI) is a medical emergency that requires prompt reperfusion therapy. Although percutaneous coronary intervention (PCI) is recognized as the standard treatment, the STEMI periprocedural pharmacological management remains a topic of debate. Upstream pre-treatment with unfractionated heparin (UFH) alongside double antiplatelet therapy (DAPT), especially with aspirin (ASA) and a P2Y12 inhibitor (iP2Y12), in pre-hospital setting is a possible approach, however evidence supporting this option is limited. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Aim: </strong>Conduct a Systematic Review and Meta-Analysis to evaluate the efficacy and safety of triple antithrombotic therapy pre-treatment (UFH + ASA + iP2Y12) versus pre-treatment DAPT (ASA + iP2Y12) followed by periprocedural UFH in STEMI patients undergoing PCI.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods: </strong>We systematically checked the Cochrane Controlled Register of Trials, EMBASE and PubMed for both interventional and observational studies comparing UFH pre-treatment alongside ASA and iP2Y12 administration versus pre-treatment DAPT with delayed UFH. Primary outcomes were all-cause mortality and major bleeding events. Secondary endpoints were spontaneous reperfusion (pre-PCI TIMI flow 2-3) and in-hospital cardiogenic shock. Our meta-analysis was conducted on a random effects model, considering a 95% confidence interval.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results: </strong>Of the 628 records from our search strategy, 8 studies were included, providing a total of 55599 patients. Our meta-analysis revealed a lower all-cause mortality within the pre-treatment group (pooled odds ratio (OR) 0,59 [0,45, 0,77], P<0,01, I²= 78%), albeit with heterogeneity. In a subgroup analysis, 30-day and 1-year mortality also showed statistical significance (pooled OR 0,67 [0,47, 0,96], P<0,01, I²=85% and pooled OR 0,44 [0,35, 0,54], P=0,86, I²=0%, respectively). <span style="color:black">There was no </span>statistical significance in in-hospital mortality (pooled OR 0.66 [0.38, 1.16], P=0,24, I²=30%) and <span style="color:black">major bleeding </span>(pooled OR 0.92 [0.78, 1.09], P=0.48, I²=0%), despite a tendency favouring the pre-treatment group in both outcomes. The pre-treatment strategy exhibited a higher rate of spontaneous reperfusion (pooled OR 1.67 [1.43, 1.96], P<0.01; I²=78%) and significant lower <span style="color:black">in-hospital cardiogenic shock (pooled OR 0.66 [0.58, 0.76], <em>P</em><0.33, I²=13%).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusions: </strong>Our study suggests the benefit and safety of upstream UFH treatment alongside ASA and iP2Y12 for STEMI patients undergoing primary PCI.</span></span></p>
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