Pretreatment with P2Y12 inhibitors in ST-elevation myocardial infarction: A systematic review and meta-analysis
Tipo
Artigo
Data de publicação
2023
Periódico
Catheterization and Cardiovascular Interventions
Citações (Scopus)
4
Autores
Gewehr D.M.
Carvalho P.E.D.P.
Dagostin C.S.
Cardoso R.
Kubrusly T.B.L.
Kubrusly F.B.
Kubrusly L.F.
Carvalho P.E.D.P.
Dagostin C.S.
Cardoso R.
Kubrusly T.B.L.
Kubrusly F.B.
Kubrusly L.F.
Orientador
Título da Revista
ISSN da Revista
Título de Volume
Membros da banca
Programa
Resumo
© 2023 Wiley Periodicals LLC.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 < 0.01). Conclusion: Our analysis suggests that pretreatment with oral P2Y12 inhibitors before PCI in patients with STEMI was not associated with reduced all-cause mortality, myocardial infarction, or major bleeding. However, pretreatment with P2Y12 inhibitors in the pre-hospital setting appears to be beneficial in reducing reinfarction.
Descrição
Palavras-chave
Assuntos Scopus
Hemorrhage , Humans , Myocardial Infarction , Observational Studies as Topic , Percutaneous Coronary Intervention , Platelet Aggregation Inhibitors , Purinergic P2Y Receptor Antagonists , ST Elevation Myocardial Infarction , Treatment Outcome