Pretreatment with P2Y12 inhibitors in ST‐elevation myocardial infarction: A systematic review and meta‐analysis

Background Pretreatment with oral P2Y12 inhibitors is a standard practice for ST‐elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). However, the efficacy and safety of P2Y12 inhibitors pretreatment remain unclear. Objectives We conducted a meta‐anal...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2023-08, Vol.102 (2), p.200-211
Main Authors: Gewehr, Douglas Mesadri, Carvalho, Pedro Emanuel de Paula, Dagostin, Caroline Serafim, Cardoso, Rhanderson, Kubrusly, Taiane Belinati Loureiro, Kubrusly, Fernando Bermudez, Kubrusly, Luiz Fernando
Format: Article
Language:English
Subjects:
acute coronary syndrome
Acute coronary syndromes
Bleeding
Clinical trials
Heart attacks
Hemorrhage
Meta-analysis
Mortality
Myocardial infarction
P2Y12 inhibitors
percutaneous coronary intervention
pretreatment
ST‐elevation myocardial infarction
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Summary:Background Pretreatment with oral P2Y12 inhibitors is a standard practice for ST‐elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). However, the efficacy and safety of P2Y12 inhibitors pretreatment remain unclear. Objectives We conducted a meta‐analysis to investigate the impact of P2Y12 inhibitor pretreatment on thrombotic and hemorrhagic endpoints in STEMI patients. Methods We searched multiple databases for studies that compared P2Y12 inhibitor pretreatment with no pretreatment in STEMI patients and reported endpoints of interest. Random effects model was used for the meta‐analysis. Results Our meta‐analysis included 3 randomized controlled trials and 14 observational studies, comprising 70,465 patients assigned to either P2Y12 inhibitor pretreatment (50,328 patients) or no pretreatment (20,137 patients). Compared to no pretreatment, P2Y12 inhibitor pretreatment did not result in significant reductions in all‐cause mortality (risk ratio [RR] 0.73; 95% confidence interval [CI]: 0.52–1.03; p = 0.07), myocardial infarction (RR 0.75; 95% CI: 0.53–1.07; p = 0.11), or major bleeding (RR 0.80; 95% CI: 0.56–1.16; p = 0.22) at 30 days. However, our subgroup analysis revealed that P2Y12 inhibitor pretreatment administered in the pre‐hospital setting was associated with a significant reduction in the incidence of myocardial infarction compared to no pretreatment (RR 0.73; 95% CI: 0.56–0.91; p 
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.30750