Coronary disease & ACSCohort study
Timing of P2Y12 Inhibitor Administration in Patients With STEMI Undergoing Primary Percutaneous Coronary Intervention (PCI)
- Prospective multicentre registry analysis
- propensity score analysis
- doubly robust weighted estimators
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
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:10.1016/j.jacc.2024.04.036
Summarised from the published abstract; every number is checked against it