P2Y12 inhibitor loading dose before catheterization in ST-segment elevation myocardial infarction: Is this the best strategy?

Guedes, J; Marques, Nuno; Azevedo, Pedro; Mota, Teresa; Bispo, João; Fernandes, Raquel; Costa, Hugo; Vinhas, Hugo; Mimoso, Jorge; Jesus, Ilídio de

doi:10.1016/j.repce.2020.09.001

Cited by 3 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The main reason to justify this nding is the fact that there was a signi cantly higher use of bailout GP-IIbIIIa in the downstream treatment cohort in several studies, drugs usually associated with increased risk of bleeding. [13][14][15][16][17][18] Also, the strategy chosen by the operator regarding medical and invasive therapy might be in uenced by the presence of pretreatment. This carries the risk of bias since the majority of included studies are observational and non-blinded.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Presume

Gomes

Ferreira

et al. 2023

Preprint

View full text Add to dashboard Cite

Introduction: Dual antiplatelet therapy (DAPT) with both aspirin and P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) has been shown to be associated with better outcomes. Yet, there is uncertainty regarding the optimal timing for its initiation. We performed a systematic review and meta-analysis of evidence on pretreatment with P2Y12 inhibitors in combination with aspirin in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods and results: We performed a systematic search of electronic databases Pubmed, CENTRAL, and Scopus until April 2022. Studies were eligible if they compared P2Y12 inhibitor upstream administration to downstream use in patients with STEMI submitted to PCI. Studies with patients receiving fibrinolysis or medical therapy only were excluded. Outcomes were assessed at the shortest follow-up available. Out of 2491 articles, 3 RCT and 16 non-RCT studies were included, with a total of 79300 patients (66.1% pretreated, 66.0% treated with Clopidogrel). Pretreatment was associated with reduction in definite stent thrombosis (OR 0.59 [0.37-0.94]), all-cause death (OR 0.77 [0.60-0.97]), and cardiogenic shock (OR 0.60 [0.48-0.75]). It was also associated with a lower incidence of TIMI flow <3 pre-PCI (OR 0.78 [0.67-0.92]). However, incidence of recurrent MI was not significantly reduced (OR 0.93 [0.57-1.52]). Regarding safety, pretreatment was not associated with a higher risk of major bleeding events (OR 0.83 [0.75-0.92]). Conclusion: Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with better pre-PCI coronary perfusion, lower incidence of definite stent thrombosis, cardiogenic shock, and, possibly, all-cause mortality with no sign of potential harm encountered.

show abstract

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Presume

Gomes

Ferreira

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…The main reason to justify this finding is the fact that there was a significantly higher use of bailout GP-IIbIIIa in the downstream treatment cohort in several studies, drugs usually associated with increased risk of bleeding. 11,13,16,20,22,27 Also, the strategy chosen by the operator regarding medical and invasive therapy may be influenced by the presence of pretreatment. This carries the risk of bias, because most included studies are observational and nonblinded.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Presume

Gomes

Ferreira

et al. 2023

Journal of Cardiovascular Pharmacology

View full text Add to dashboard Cite

Dual antiplatelet therapy (DAPT) with both aspirin and P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) has been shown to be associated with better outcomes. Yet, there is uncertainty regarding the optimal timing for its initiation. We performed a systematic review and meta-analysis of evidence on pretreatment with P2Y12 inhibitors in combination with aspirin in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We performed a systematic search of electronic databases Pubmed, CENTRAL, and Scopus until April 2022. Studies were eligible if they compared P2Y12 inhibitor upstream administration to downstream use in patients with STEMI submitted to PCI. Studies with patients receiving fibrinolysis or medical therapy only were excluded. Outcomes were assessed at the shortest follow-up available. Out of 2491 articles, 3 RCT and 16 non-RCT studies were included, with a total of 79300 patients (66.1% pretreated, 66.0% treated with Clopidogrel). Pretreatment was associated with reduction in definite stent thrombosis (OR 0.61 [0.38-0.98]), all-cause death (OR 0.77 [0.60-0.97]), and cardiogenic shock (OR 0.60 [0.48-0.75]). It was also associated with a lower incidence of TIMI flow <3 pre-PCI (OR 0.78 [0.67-0.92]). However, incidence of recurrent MI was not significantly reduced (OR 0.93 [0.57-1.52]). Regarding safety, pretreatment was not associated with a higher risk of major bleeding events (OR 0.83 [0.75-0.92]). Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with better pre-PCI coronary perfusion, lower incidence of definite stent thrombosis, cardiogenic shock, and, possibly, all-cause mortality with no sign of potential harm encountered.

show abstract

Pharmacological Approaches to Limit Ischemic and Reperfusion Injuries of the Heart: Analysis of Experimental and Clinical Data on P2Y₁₂ Receptor Antagonists

et al. 2022

View full text Add to dashboard Cite

Author's summary High mortality among people with acute myocardial infarction is one of the most urgent problems of modern cardiology. And in recent years, much attention has been paid to the search for pharmacological approaches to prevent heart damage. In this review, we tried to analyze data on the effect of P2Y 12 receptor antagonists on the ischemia/reperfusion tolerance of the heart.

show abstract

P2Y12 inhibitor loading dose before catheterization in ST-segment elevation myocardial infarction: Is this the best strategy?

Cited by 3 publications

References 24 publications

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Pharmacological Approaches to Limit Ischemic and Reperfusion Injuries of the Heart: Analysis of Experimental and Clinical Data on P2Y₁₂ Receptor Antagonists

Contact Info

Product

Resources

About

P2Y12 inhibitor loading dose before catheterization in ST-segment elevation myocardial infarction: Is this the best strategy?

Cited by 3 publications

References 24 publications

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Effectiveness and safety of P2Y12 inhibitor pretreatment for primary PCI in STEMI: Systematic review and meta-analysis

Pharmacological Approaches to Limit Ischemic and Reperfusion Injuries of the Heart: Analysis of Experimental and Clinical Data on P2Y12 Receptor Antagonists

Contact Info

Product

Resources

About

Pharmacological Approaches to Limit Ischemic and Reperfusion Injuries of the Heart: Analysis of Experimental and Clinical Data on P2Y₁₂ Receptor Antagonists