Key result
Early P2Y12 inhibition significantly reduced major adverse cardiac events compared to delayed inhibition in STEMI patients undergoing PCI (OR 0.73; 95% CI 0.61-0.88; p=0.0008).
Why the study?
Does early P2Y12 inhibition reduce MACE in patients undergoing PCI for STEMI compared to delayed P2Y12 inhibition?
Meta-Analysis (n=9,648)
Does early P2Y12 inhibition reduce MACE in patients undergoing PCI for STEMI compared to delayed P2Y12 inhibition?
Odds Ratio: 0.73 (95% CI 0.61–0.88)
p-value: p=0.0008
Early P2Y12 inhibition in STEMI patients undergoing PCI significantly reduces MACE and myocardial infarction without increasing major bleeding compared to delayed administration.
Supports early P2Y12 inhibition in STEMI PCI to reduce MACE without excess bleeding; extends low-certainty evidence from prior studies.
AIMS: The aim of this meta-analysis was to compare the benefit of "early" vs. "delayed" P2Y12 inhibition in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: We conducted a meta-analysis including seven randomised controlled trials (RCTs) which compared early vs. delayed P2Y12inhibition in STEMI patients scheduled for PCI, providing data on major adverse cardiac events (MACE), all-cause death, and major bleeding. The primary endpoint was MACE. Secondary endpoints included stent thrombosis and the use of GP IIb/IIIa inhibitors (GPI). All endpoints were analysed at the shortest follow-up available. A total of 9,648 patients were included ("early"=4,792, "delayed"=4,856). "Early" P2Y12 inhibition was associated with a significant reduction in MACE rate (OR 0.73, 95% CI: 0.61-0.88, p=0.0008), myocardial infarction (OR 0.71, 95% CI: 0.57-0.90, p=0.004), bail-out GPI use (OR 0.87, 95% CI: 0.75-1.00, p=0.04) and improved coronary reperfusion before PCI (OR for Thrombolysis In Myocardial Infarction [TIMI] flow grade 2-3=1.12, 95% CI: 1.00-1.26, p=0.04). Major bleeding was not increased (OR 0.87, 95% CI: 0.62-1.21, p=0.41). CONCLUSIONS: A strategy of early effective P2Y12 inhibition in PCI of STEMI appears to improve coronary reperfusion before PCI, and reduce MACE, MI and bail-out GPI use without increase of major bleeding.
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Bellemain-Appaix et al. (2018) conducted a meta-analysis in ST-elevation myocardial infarction (STEMI) (n=9,648). Early P2Y12 inhibition vs. Delayed P2Y12 inhibition was evaluated on Major adverse cardiac events (MACE) (OR 0.73, 95% CI 0.61-0.88, p=0.0008). Early P2Y12 inhibition significantly reduced major adverse cardiac events compared to delayed inhibition in STEMI patients undergoing PCI (OR 0.73; 95% CI 0.61-0.88; p=0.0008).
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