The efficacy of early versus delayed P2Y12 inhibition in percutaneous coronary intervention for ST-elevation myocardial infarction: a systematic review and meta-analysis

EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
Anne Bellemain-AppaixGilles Montalescot

Abstract

The aim of this meta-analysis was to compare the benefit of "early" vs. "delayed" P2Y12 inhibition in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). We conducted a meta-analysis including seven randomised controlled trials (RCTs) which compared early vs. delayed P2Y12inhibition in STEMI patients scheduled for PCI, providing data on major adverse cardiac events (MACE), all-cause death, and major bleeding. The primary endpoint was MACE. Secondary endpoints included stent thrombosis and the use of GP IIb/IIIa inhibitors (GPI). All endpoints were analysed at the shortest follow-up available. A total of 9,648 patients were included ("early"=4,792, "delayed"=4,856). "Early" P2Y12 inhibition was associated with a significant reduction in MACE rate (OR 0.73, 95% CI: 0.61-0.88, p=0.0008), myocardial infarction (OR 0.71, 95% CI: 0.57-0.90, p=0.004), bail-out GPI use (OR 0.87, 95% CI: 0.75-1.00, p=0.04) and improved coronary reperfusion before PCI (OR for Thrombolysis In Myocardial Infarction [TIMI] flow grade 2-3=1.12, 95% CI: 1.00-1.26, p=0.04). Major bleeding was not increased (OR 0.87, 95% CI: 0.62-1.21, p=0.41). A strategy of early effective P2Y12 inhibition in PCI of STEM...Continue Reading

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Citations

Nov 27, 2019·Journal of the American Heart Association·Ravi K Sharma, Duane S Pinto
Jul 11, 2019·Applied Immunohistochemistry & Molecular Morphology : AIMM·Rosario Barranco, Francesco Ventura
Mar 25, 2020·Journal of Interventional Cardiology·Thabo MahendiranStephane Fournier
Oct 26, 2018·Circulation. Cardiovascular Interventions·Nicolas DanchinUNKNOWN FAST-MI Investigators
May 23, 2020·Journal of the American College of Cardiology·Peter SinnaeveMarco Valgimigli

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