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

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dc.contributor.authorGewehr D.M.
dc.contributor.authorCarvalho P.E.D.P.
dc.contributor.authorDagostin C.S.
dc.contributor.authorCardoso R.
dc.contributor.authorKubrusly T.B.L.
dc.contributor.authorKubrusly F.B.
dc.contributor.authorKubrusly L.F.
dc.date.accessioned2024-09-01T06:18:31Z
dc.date.available2024-09-01T06:18:31Z
dc.date.issued2023
dc.description.abstract© 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.
dc.description.firstpage200
dc.description.issuenumber2
dc.description.lastpage211
dc.description.volume102
dc.identifier.doi10.1002/ccd.30750
dc.identifier.issnNone
dc.identifier.urihttps://dspace.mackenzie.br/handle/10899/39295
dc.relation.ispartofCatheterization and Cardiovascular Interventions
dc.rightsAcesso Restrito
dc.subject.otherlanguageacute coronary syndrome
dc.subject.otherlanguageP2Y12 inhibitors
dc.subject.otherlanguagepercutaneous coronary intervention
dc.subject.otherlanguagepretreatment
dc.subject.otherlanguageST-elevation myocardial infarction
dc.titlePretreatment with P2Y12 inhibitors in ST-elevation myocardial infarction: A systematic review and meta-analysis
dc.typeArtigo
local.scopus.citations4
local.scopus.eid2-s2.0-85162866629
local.scopus.subjectHemorrhage
local.scopus.subjectHumans
local.scopus.subjectMyocardial Infarction
local.scopus.subjectObservational Studies as Topic
local.scopus.subjectPercutaneous Coronary Intervention
local.scopus.subjectPlatelet Aggregation Inhibitors
local.scopus.subjectPurinergic P2Y Receptor Antagonists
local.scopus.subjectST Elevation Myocardial Infarction
local.scopus.subjectTreatment Outcome
local.scopus.updated2025-04-01
local.scopus.urlhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85162866629&origin=inward
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