Timing of P2Y12 Inhibitor Administration in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention (PCI)
Authors' conclusion
In contemporary patients with STEMI transferred for primary PCI, pretreatment with P2Y12 inhibitors was associated with a significant time-dependent reduction of 30-day MACE without increasing bleeding risk.
Study context
- Population
- Patients with STEMI transferred for primary PCI within a regional STEMI network
- Participants
- 1,624 patients
- Exposure
- P2Y12 inhibitor pretreatment vs in-cath lab administration
- Pretreatmentn = 1,033
- Cath labn = 591reference
- Outcome
- MACE, major bleeding, and net adverse clinical events (MACE or major bleeding)
- Follow-up
- 30 days of index admission
Methodological detailspropensity score analysis, doubly robust weighted estimators
- Propensity score analysis
- Doubly robust weighted estimators
Main finding
As reported in the abstract
MACE · 30 days
Pretreatment vs Cath labAdjusted hazard ratio (95% CI)
MACE
0.53(0.37–0.76)
Net adverse clinical events
0.47(0.26–0.86)
Observational data: associations, not effects.
Further findings
Major adverse cardiac events (MACE), by time from P2Y12 inhibitor administration to PCI
- Significant treatment-by-time interaction; benefit of pretreatment only apparent when time to PCI >80 minutes
Safety
| Outcome | Adjusted HR (95% CI) | |
|---|---|---|
| Major bleeding · 30 days | 0.62 (0.36–1.05) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Original publication
Timing of P2Y12 Inhibitor Administration in Patients With STEMI Undergoing Primary PCI. J Am Coll Cardiol. Published 25 June 2024. doi:10.
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