Pre-treatment with oral P2Y12 inhibitors in AMI-CS patients increased major bleeding risk by 48% (wHR 1.48) without reducing 30-day major adverse cardiovascular events.
Does pre-treatment with an oral loading dose of a P2Y12 inhibitor reduce MACE or increase major bleeding in patients with acute myocardial infarction complicated with cardiogenic shock?
Pre-treatment with oral P2Y12 inhibitors before angiography in patients with AMI and cardiogenic shock increases the risk of major bleeding without reducing 30-day major adverse cardiovascular events.
Absolute Event Rate: 0% vs 0%
Abstract Background There are currently no data regarding pre-treatment with P2Y12 inhibitors in patients with acute myocardial infarction complicated with cardiogenic shock (AMI-CS). Objectives To evaluate the efficacy and safety of pre-treatment with P2Y12 inhibitors in patients with AMI-CS. Methods Using the ACTION-SHOCK cohort, we included consecutive patients hospitalized between 2012 and 2023 with AMI-CS admitted for coronary angiography within 24 hours of admission. Pre-treatment was defined by the administration before angiography of an oral loading dose of a P2Y12 inhibitor. We evaluated the association between pre-treatment and either major adverse cardiovascular events (MACE) or major bleeding at 30 days after admission, using an Inverse Probability Weighting (IPW) approach. MACE was defined by the composite of all-cause death, ischemic stroke, myocardial infarction, or stent thrombosis. Major bleeding was defined by BARC grade 3, 4, or 5. Results Among the 421 patients with AMI-CS admitted to the catheterization laboratory within 24 hours of admission, 224 (53.2%) patients received pre-treatment with a P2Y12 inhibitor. No association between pre-treatment with P2Y12 inhibitor and MACE at 30 days was found (42.1% vs 38.8% - IPW hazard ratio (wHR): 1.11, 95% CI: 0.82-1.50). Pre-treatment was associated with an increased risk of major bleedings (42.2% vs 32.3% - wHR: 1.48, 95% CI: 1.05-2.08). The effect of pre-treatment on MACE or major bleeding at 30 days is consistent across STEMI / NSTEMI patients. Conclusion In patients with AMI-CS, pretreatment with a P2Y12 inhibitor oral load was associated with an increased risk of major bleeding without benefit on MACE.Central illustration
Elhadad et al. (Sat,) reported a other. Pre-treatment with oral P2Y12 inhibitors in AMI-CS patients increased major bleeding risk by 48% (wHR 1.48) without reducing 30-day major adverse cardiovascular events.
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