Key result
Prehospital P2Y12 inhibitors improve pre-PCI TIMI flow and reduce recurrent MI vs in-hospital dosing without excess bleeding.
Why the study?
Although early P2Y12 inhibitor administration in STEMI patients undergoing primary PCI is widely accepted, whether prehospital administration yields greater coronary reperfusion remains unclear.
Does prehospital P2Y12 inhibitor administration improve coronary reperfusion and safety compared to in-hospital administration in STEMI patients undergoing primary PCI?
Meta-Analysis
Does prehospital P2Y12 inhibitor administration improve coronary reperfusion and safety compared to in-hospital administration in STEMI patients undergoing primary PCI?
p-value: p=0.61
Prehospital administration of P2Y12 inhibitors in STEMI patients undergoing primary PCI improves early coronary reperfusion and reduces recurrent MI without increasing the risk of major bleeding.
Supports prehospital P2Y12 use in STEMI; extends low-certainty meta-analysis but requires confirmation before practice change.
BACKGROUND: The concept of early administration of P2Y12 inhibitor in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is widely accepted, but whether prehospital administration results in greater coronary reperfusion remains unclear. Our study aims to analyze the benefit and safety of prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor administration. METHOD: Three databases (PubMed, EMBASE, and Cochrane Library) were searched from database inception to June 2023. We included all types of studies except for conference publications, abstract presentations, reviews, and case reports. The primary outcomes were pre-PCI TIMI flow grade 2-3 (TIMI = Thrombolysis in Myocardial Infarction) and major bleeding. The secondary outcomes included post-PCI TIMI flow grade 2-3, major adverse cardiac events (MACE), recurrent myocardial infarction (MI), and short-term (30-day) mortality. CONCLUSION: Prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor is associated with a significantly higher rate of pre-PCI and post-PCI TIMI flow grade 2-3, a reduced risk of recurrent MI, and no increase in major bleeding in STEMI patients undergoing primary PCI.
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Chou et al. (2023) conducted a meta-analysis in ST-elevation myocardial infarction (STEMI). Prehospital P2Y12 inhibitor vs. In-hospital P2Y12 inhibitor was evaluated on Pre-PCI TIMI flow grade 2-3 and major bleeding (p=0.61). Prehospital P2Y12 inhibitor administration significantly improved pre-PCI TIMI flow and reduced recurrent MI without increasing major bleeding (P=0.61) compared to in-hospital administration.
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