Timing of P2Y12 Inhibitor Administration in Patients With STEMI Undergoing Primary PCI,Journal of the American College of Cardiology

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Timing of P2Y12 Inhibitor Administration in Patients With STEMI Undergoing Primary PCI
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2024-06-17 , DOI: 10.1016/j.jacc.2024.04.036
Manuel Almendro-Delia ₁ , Begoña Hernández-Meneses ₁ , Gloria Padilla-Rodríguez ₁ , Emilia Blanco-Ponce ₂ , Jose Andres Arboleda-Sánchez ₃ , Juan Carlos Rodríguez-Yáñez ₄ , José Manuel Soto-Blanco ₅ , Isabel Fernández-García ₆ , José M Castillo-Caballero ₇ , Juan C García-Rubira ₁ , Rafael Hidalgo-Urbano ₁

Affiliation

The optimal timing of P2Y inhibitor administration in patients with ST-segment elevation myocardial infarction (STEMI) has not been completely elucidating. This analysis from a prospective multicenter registry sought to assess the safety and effectiveness of P2Y inhibitor pretreatment in patients transferred for primary percutaneous coronary intervention (PCI) within a regional STEMI network. Pretreatment was defined as P2Y inhibitor administration before coronary angiography. Endpoints were major adverse cardiac events (MACE), major bleeding, and net adverse clinical events, a composite of MACE or major bleeding, within 30 days of index admission. Association of P2Y inhibitor pretreatment with outcomes was modeled using doubly robust weighted estimators based on propensity score analysis. Of 1,624 patients included, 1,033 received P2Y inhibitors before angiography and 591 in the catheterization laboratory (cath lab). The non-pretreated cohort more often had history of coronary artery disease and were more likely to receive antiplatelet therapy before the index admission. After adjustment for confounding and dependent censoring, pretreatment with P2Y inhibitors predicted lower risk of MACE (adjusted HR: 0.53; 95% CI: 0.37-0.76), without increasing bleeding risk (adjusted HR: 0.62; 95% CI: 0.36-1.05), resulting in superior net clinical benefit (adjusted HR: 0.47; 95% CI: 0.26-0.86) compared with in-cath lab administration of P2Y inhibitors. There was a significant treatment-by-time interaction for MACE risk, whereby the observed benefits of pretreatment only became apparent when time between P2Y inhibitor administration and PCI was longer than 80 minutes. In contemporary patients with STEMI transferred for primary PCI, pretreatment with P2Y inhibitors was associated with a significant time-dependent reduction of 30-day MACE without increasing bleeding risk.

中文翻译：

接受直接 PCI 的 STEMI 患者中 P2Y12 抑制剂的给药时机

ST 段抬高型心肌梗死 (STEMI) 患者服用 P2Y 抑制剂的最佳时机尚未完全阐明。这项来自前瞻性多中心注册的分析旨在评估 P2Y 抑制剂预处理对区域 STEMI 网络内转入直接经皮冠状动脉介入治疗 (PCI) 的患者的安全性和有效性。预处理定义为冠状动脉造影前给予 P2Y 抑制剂。终点是入院后 30 天内的主要不良心脏事件 (MACE)、大出血和净不良临床事件（MACE 或大出血的复合事件）。使用基于倾向评分分析的双稳健加权估计量对 P2Y 抑制剂预处理与结果的关联进行建模。在 1,624 名患者中，1,033 名患者在血管造影前接受了 P2Y 抑制剂治疗，591 名患者在导管实验室（cath lab）接受了 P2Y 抑制剂治疗。未经预处理的队列更常有冠状动脉疾病史，并且更有可能在入院前接受抗血小板治疗。调整混杂因素和依赖性审查后，P2Y抑制剂预处理预测MACE风险较低（调整后HR：0.53；95％CI：0.37-0.76），而不会增加出血风险（调整后HR：0.62；95％CI：0.36-1.05），与 P2Y 抑制剂的导管内实验室给药相比，具有更高的净临床效益（调整后 HR：0.47；95% CI：0.26-0.86）。 MACE 风险存在显着的治疗时间交互作用，只有当 P2Y 抑制剂给药和 PCI 之间的时间间隔超过 80 分钟时，观察到的预处理益处才变得明显。在当代 STEMI 转入直接 PCI 的患者中，P2Y 抑制剂预处理与 30 天 MACE 的显着时间依赖性减少相关，且不会增加出血风险。

更新日期：2024-06-17

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