Effect of prehospital treatment in STEMI patients undergoing primary PCI

Fabris, Enrico; Menzio, Sara; Gregorio, Caterina; Pezzato, Andrea; Stolfo, Davide; Aleksova, Aneta; Vitrella, Giancarlo; Rakar, Serena; Perkan, Andrea; Hof, Arnoud W J van 't; Sinagra, Gianfranco

doi:10.1002/ccd.30153

Cited by 11 publications

(5 citation statements)

References 25 publications

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“…In the study by Ducci et al 24 (Load&Go Trial), the authors summarized the outcomes of clopidogrel 600 and 900 mg in the same arm; however, we obtained the dose‐stratified data from the authors through email. Finally, 3 RCTs and 14 observational studies met all the proposed inclusion criteria and were included in the primary analysis 8–11,13,24–35 …”

Section: Resultsmentioning

confidence: 99%

“…Finally, 3 RCTs and 14 observational studies met all the proposed inclusion criteria and were included in the primary analysis. [8][9][10][11]13,[24][25][26][27][28][29][30][31][32][33][34][35] We included a total of 70,465 patients in the analysis, with 50,328 (71.4%) patients assigned to pretreatment with a P2Y12 inhibitor and 20,137 (28.6%) assigned to no pretreatment. The main characteristics of the included studies are detailed in Table 1, while Table S1 summarized the clinical baseline characteristics of the included patients.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

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Pretreatment with P2Y12 inhibitors in ST‐elevation myocardial infarction: A systematic review and meta‐analysis

Gewehr,

Carvalho,

Dagostin

et al. 2023

Cathet Cardio Intervent

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Background Pretreatment with oral P2Y12 inhibitors is a standard practice for ST‐elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI). However, the efficacy and safety of P2Y12 inhibitors pretreatment remain unclear. Objectives We conducted a meta‐analysis to investigate the impact of P2Y12 inhibitor pretreatment on thrombotic and hemorrhagic endpoints in STEMI patients. Methods We searched multiple databases for studies that compared P2Y12 inhibitor pretreatment with no pretreatment in STEMI patients and reported endpoints of interest. Random effects model was used for the meta‐analysis. Results Our meta‐analysis included 3 randomized controlled trials and 14 observational studies, comprising 70,465 patients assigned to either P2Y12 inhibitor pretreatment (50,328 patients) or no pretreatment (20,137 patients). Compared to no pretreatment, P2Y12 inhibitor pretreatment did not result in significant reductions in all‐cause mortality (risk ratio [RR] 0.73; 95% confidence interval [CI]: 0.52–1.03; p = 0.07), myocardial infarction (RR 0.75; 95% CI: 0.53–1.07; p = 0.11), or major bleeding (RR 0.80; 95% CI: 0.56–1.16; p = 0.22) at 30 days. However, our subgroup analysis revealed that P2Y12 inhibitor pretreatment administered in the pre‐hospital setting was associated with a significant reduction in the incidence of myocardial infarction compared to no pretreatment (RR 0.73; 95% CI: 0.56–0.91; p < 0.01). Conclusion Our analysis suggests that pretreatment with oral P2Y12 inhibitors before PCI in patients with STEMI was not associated with reduced all‐cause mortality, myocardial infarction, or major bleeding. However, pretreatment with P2Y12 inhibitors in the pre‐hospital setting appears to be beneficial in reducing reinfarction.

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Section: Resultsmentioning

confidence: 99%

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Pretreatment with P2Y12 inhibitors in ST‐elevation myocardial infarction: A systematic review and meta‐analysis

Gewehr,

Carvalho,

Dagostin

et al. 2023

Cathet Cardio Intervent

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“…The main reason to justify this finding is the fact that there was a significantly higher use of bailout GP-IIbIIIa in the downstream treatment cohort in several studies, drugs usually associated with increased risk of bleeding. 11,13,16,20,22,27 Also, the strategy chosen by the operator regarding medical and invasive therapy may be influenced by the presence of pretreatment. This carries the risk of bias, because most included studies are observational and nonblinded.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of P2Y12 Inhibitor Pretreatment for Primary PCI in STEMI: Systematic Review and Meta-analysis

Presume

Gomes

Ferreira

et al. 2023

Journal of Cardiovascular Pharmacology

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Dual antiplatelet therapy (DAPT) with both aspirin and P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) has been shown to be associated with better outcomes. Yet, there is uncertainty regarding the optimal timing for its initiation. We performed a systematic review and meta-analysis of evidence on pretreatment with P2Y12 inhibitors in combination with aspirin in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). We performed a systematic search of electronic databases Pubmed, CENTRAL, and Scopus until April 2022. Studies were eligible if they compared P2Y12 inhibitor upstream administration to downstream use in patients with STEMI submitted to PCI. Studies with patients receiving fibrinolysis or medical therapy only were excluded. Outcomes were assessed at the shortest follow-up available. Out of 2491 articles, 3 RCT and 16 non-RCT studies were included, with a total of 79300 patients (66.1% pretreated, 66.0% treated with Clopidogrel). Pretreatment was associated with reduction in definite stent thrombosis (OR 0.61 [0.38-0.98]), all-cause death (OR 0.77 [0.60-0.97]), and cardiogenic shock (OR 0.60 [0.48-0.75]). It was also associated with a lower incidence of TIMI flow <3 pre-PCI (OR 0.78 [0.67-0.92]). However, incidence of recurrent MI was not significantly reduced (OR 0.93 [0.57-1.52]). Regarding safety, pretreatment was not associated with a higher risk of major bleeding events (OR 0.83 [0.75-0.92]). Pretreatment with DAPT, including a P2Y12 inhibitor, was associated with better pre-PCI coronary perfusion, lower incidence of definite stent thrombosis, cardiogenic shock, and, possibly, all-cause mortality with no sign of potential harm encountered.

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“…We analyzed all consecutive STEMI patients who underwent primary PCI between 1 January 2010 and 31 December 2019 and were enrolled in the 'Trieste University Hospital pPCI Registry', 10,11 which includes clinical, instrumental, and procedural data. We cross-matched these data with those present in the 'Trieste University Hospital ICD registry', which includes the ICDs implanted in Trieste and Trieste's spoke hospitals.…”

Section: Study Populationmentioning

confidence: 99%

Implantable-cardioverter-defibrillator after ST-elevation myocardial infarction: when and how frequently is it implanted and what is the rate of appropriate interventions? Insight from Trieste registry

Pezzato,

Fabris,

Gregorio

et al. 2023

Journal of Cardiovascular Medicine

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Background There are limited data on implantable-cardioverter-defibrillator (ICD) implantation after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI). Therefore, we evaluated when and how frequently an ICD is implanted after pPCI, the rate of appropriate ICD interventions, and predictors of ICD implantation. Methods We analyzed STEMI patients treated with pPCI at the University Hospital of Trieste, Italy, between January 2010 and December 2019. We cross-matched patients’ data with those present in the Trieste ICD registry. Results Among 1805 consecutive patients treated with pPCI, 3.6% underwent ICD implantation during a median follow-up of 6.7 [interquartile range (IQR) 4.3–9.2] years. At 12 months, the mean number of ICD implantations was 2.3/100 patients [95% confidence interval (95% CI) 1.7–3.1] and remained stable over time (at 24 months: 2.5/100 patients, 95% CI 2.0–3.5 and at 36 months: 2.6/100 patients, 95% CI 2.3–3.8); 83.1% of ICDs were implanted for primary prevention, and more than half (55%) were implanted in patients with ejection fraction more than 35% at the moment of STEMI discharge. The rate of appropriate ICD interventions was 16.9% at a median follow-up of 5.7 years (IQR 3.3–8.3 years) after ICD implantation. At 12 months, the mean number of appropriate ICD interventions was 5/100 patients and 7/100 patients after 24 months. In patients with ejection fraction more than 35% at STEMI discharge (median ejection fraction 43%; IQR 40–48), independent predictors of ICD implantation were male sex, anterior STEMI and troponin peak more than 100 000 ng/dl. Conclusion The rate of ICD implantations after pPCI is low; however, the rate of appropriate ICD interventions is high. A relevant subgroup of patients received ICD implantations at follow-up despite a nonsevere ejection fraction at discharge after STEMI. Among these patients, those with high troponin release deserve strict follow-up and full optimal medical treatment.

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Effect of prehospital treatment in STEMI patients undergoing primary PCI

Cited by 11 publications

References 25 publications

Pretreatment with P2Y12 inhibitors in ST‐elevation myocardial infarction: A systematic review and meta‐analysis

Pretreatment with P2Y12 inhibitors in ST‐elevation myocardial infarction: A systematic review and meta‐analysis

Effectiveness and Safety of P2Y12 Inhibitor Pretreatment for Primary PCI in STEMI: Systematic Review and Meta-analysis

Implantable-cardioverter-defibrillator after ST-elevation myocardial infarction: when and how frequently is it implanted and what is the rate of appropriate interventions? Insight from Trieste registry

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