Pretreatment With P2Y12 Inhibitors in ST-Segment Elevation Myocardial Infarction: Insights From the Bern-PCI Registry

Miklos Rohla; Shirley Xinyu Ye; Hiroki Shibutani; Jolie Bruno; Tatsuhiko Otsuka; Jonas D Häner; Sarah Bär; Fabrice Temperli; Raminta Kavaliauskaite; Jonas Lanz; Stefan Stortecky; Fabien Praz; Lukas Hunziker; Thomas Pilgrim; George Cm Siontis; Sylvain Losdat; Stephan Windecker; Lorenz Räber

doi:10.1016/j.jcin.2023.10.064

Pretreatment With P2Y₁₂ Inhibitors in ST-Segment Elevation Myocardial Infarction: Insights From the Bern-PCI Registry

JACC Cardiovasc Interv. 2024 Jan 8;17(1):17-28. doi: 10.1016/j.jcin.2023.10.064.

Authors

Miklos Rohla¹, Shirley Xinyu Ye¹, Hiroki Shibutani², Jolie Bruno¹, Tatsuhiko Otsuka¹, Jonas D Häner¹, Sarah Bär¹, Fabrice Temperli¹, Raminta Kavaliauskaite¹, Jonas Lanz¹, Stefan Stortecky¹, Fabien Praz¹, Lukas Hunziker¹, Thomas Pilgrim¹, George Cm Siontis¹, Sylvain Losdat³, Stephan Windecker¹, Lorenz Räber⁴

Affiliations

¹ Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
² Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan.
³ Clinical Trials Unit, University of Bern, Bern, Switzerland.
⁴ Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland. Electronic address: lorenz.raeber@insel.ch.

PMID: 38199749
DOI: 10.1016/j.jcin.2023.10.064

Abstract

Background: Evidence to support immediate P2Y₁₂ inhibitor loading in ST-segment elevation myocardial infarction (STEMI) is limited.

Objectives: This study sought to compare outcomes of STEMI patients receiving immediate or delayed P2Y₁₂ inhibitor treatment.

Methods: Using data from the prospective Bern-PCI registry between 2016 and 2020, we stratified STEMI patients undergoing percutaneous coronary intervention according to time periods with different institutional recommendations regarding P2Y₁₂ inhibitor pretreatment. In cohort 1 (October 2016-September 2018), immediate P2Y₁₂ inhibitor treatment was recommended. In cohort 2 (October 2018-September 2020), P2Y₁₂ inhibitor treatment was recommended after coronary anatomy was confirmed. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events (MACCEs) defined as all-cause death, recurrent myocardial infarction, stroke, or definite stent thrombosis at 30 days. Sensitivity analysis included only patients in whom these recommendations were followed.

Results: Cohort 1 included 1,116 patients; pretreatment was actually given in 708 (63.4%). Cohort 2 included 847 patients; pretreatment was withheld in 798 (94.2%). The mean age was 65 ± 13 years, and 24% were female. Baseline characteristics were well-balanced between groups. The median difference for P2Y₁₂ loading to angiography was 52 minutes between cohort 1 and 2 and 100 minutes between patients receiving vs not receiving pretreatment. Rates of MACCEs were similar between cohort 1 and cohort 2 (10.1% vs 8.1%; adjusted HR: 0.91; 95% CI: 0.65-1.28; P = 0.59) and between patients receiving vs not receiving pretreatment (7.1% vs 8.4%; adjusted HR: 1.17; 95% CI: 0.78-1.74; P = 0.45).

Conclusions: In this cohort study of patients with STEMI undergoing primary percutaneous coronary intervention, P2Y₁₂ inhibitor pretreatment was not associated with improved MACCEs.

Keywords: P2Y(12) inhibitors; ST-elevational myocardial infarction; dual antiplatelet therapy.

MeSH terms

Aged
Cohort Studies
Female
Humans
Male
Middle Aged
Percutaneous Coronary Intervention* / adverse effects
Prospective Studies
Registries
ST Elevation Myocardial Infarction* / diagnostic imaging
ST Elevation Myocardial Infarction* / therapy
Treatment Outcome