AIMS: The aim of this meta-analysis was to compare the benefit of "early" vs. "delayed" P2Y12 inhibition in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: We conducted a meta-analysis including seven randomised controlled trials (RCTs) which compared early vs. delayed P2Y12inhibition in STEMI patients scheduled for PCI, providing data on major adverse cardiac events (MACE), all-cause death, and major bleeding. The primary endpoint was MACE. Secondary endpoints included stent thrombosis and the use of GP IIb/IIIa inhibitors (GPI). All endpoints were analysed at the shortest follow-up available. A total of 9,648 patients were included ("early"=4,792, "delayed"=4,856). "Early" P2Y12 inhibition was associated with a significant reduction in MACE rate (OR 0.73, 95% CI: 0.61-0.88, p=0.0008), myocardial infarction (OR 0.71, 95% CI: 0.57-0.90, p=0.004), bail-out GPI use (OR 0.87, 95% CI: 0.75-1.00, p=0.04) and improved coronary reperfusion before PCI (OR for Thrombolysis In Myocardial Infarction [TIMI] flow grade 2-3=1.12, 95% CI: 1.00-1.26, p=0.04). Major bleeding was not increased (OR 0.87, 95% CI: 0.62-1.21, p=0.41). CONCLUSIONS: A strategy of early effective P2Y12 inhibition in PCI of STEMI appears to improve coronary reperfusion before PCI, and reduce MACE, MI and bail-out GPI use without increase of major bleeding.
AIMS: The aim of this meta-analysis was to compare the benefit of "early" vs. "delayed" P2Y12 inhibition in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: We conducted a meta-analysis including seven randomised controlled trials (RCTs) which compared early vs. delayed P2Y12inhibition in STEMI patients scheduled for PCI, providing data on major adverse cardiac events (MACE), all-cause death, and major bleeding. The primary endpoint was MACE. Secondary endpoints included stent thrombosis and the use of GP IIb/IIIa inhibitors (GPI). All endpoints were analysed at the shortest follow-up available. A total of 9,648 patients were included ("early"=4,792, "delayed"=4,856). "Early" P2Y12 inhibition was associated with a significant reduction in MACE rate (OR 0.73, 95% CI: 0.61-0.88, p=0.0008), myocardial infarction (OR 0.71, 95% CI: 0.57-0.90, p=0.004), bail-out GPI use (OR 0.87, 95% CI: 0.75-1.00, p=0.04) and improved coronary reperfusion before PCI (OR for Thrombolysis In Myocardial Infarction [TIMI] flow grade 2-3=1.12, 95% CI: 1.00-1.26, p=0.04). Major bleeding was not increased (OR 0.87, 95% CI: 0.62-1.21, p=0.41). CONCLUSIONS: A strategy of early effective P2Y12 inhibition in PCI of STEMI appears to improve coronary reperfusion before PCI, and reduce MACE, MI and bail-out GPI use without increase of major bleeding.
Authors: Farzin Beygui; Vincent Roule; Fabrice Ivanes; Thierry Dechery; Olivier Bizeau; Laurent Roussel; Philippe Dequenne; Marc-Antoine Arnould; Nicolas Combaret; Jean Philippe Collet; Philippe Commeau; Guillaume Cayla; Gilles Montalescot; Hakim Benamer; Pascal Motreff; Denis Angoulvant; Pierre Marcollet; Stephan Chassaing; Katrien Blanchart; René Koning; Grégoire Rangé Journal: Front Cardiovasc Med Date: 2022-03-11
Authors: Enrico Fabris; Serge Korjian; Barry S Coller; Jurrien M Ten Berg; Christopher B Granger; C Michael Gibson; Arnoud W J van 't Hof Journal: Thromb Haemost Date: 2021-04-30 Impact factor: 6.681
Authors: Thabo Mahendiran; David Nanchen; David Meier; Baris Gencer; Roland Klingenberg; Lorenz Räber; David Carballo; Christian M Matter; Thomas F Lüscher; Stephan Windecker; François Mach; Nicolas Rodondi; Olivier Muller; Stephane Fournier Journal: J Interv Cardiol Date: 2020-03-03 Impact factor: 2.279
Authors: Christian Dworeck; Björn Redfors; Oskar Angerås; Inger Haraldsson; Jacob Odenstedt; Dan Ioanes; Petur Petursson; Sebastian Völz; Jonas Persson; Sasha Koul; Dimitrios Venetsanos; Anders Ulvenstam; Robin Hofmann; Jens Jensen; Per Albertsson; Truls Råmunddal; Anders Jeppsson; David Erlinge; Elmir Omerovic Journal: JAMA Netw Open Date: 2020-10-01