Key result
In STEMI patients treated during the COVID-19 pandemic, in-hospital cardiac mortality was significantly higher with clopidogrel (21.9%) compared to ticagrelor (6.7%) and prasugrel (1.6%).
Why the study?
COVID-19 increases thrombotic and hemorrhagic risks, raising questions about the efficacy and safety of dual antiplatelet therapy in patients with STEMI during this era.
Do different P2Y12 inhibitors have different efficacy and safety profiles in STEMI patients undergoing primary PCI during the COVID-19 era?
Cohort (n=390)
No
Do different P2Y12 inhibitors have different efficacy and safety profiles in STEMI patients undergoing primary PCI during the COVID-19 era?
In STEMI patients undergoing primary PCI during the COVID-19 era, clopidogrel was associated with higher cardiac mortality compared to prasugrel and ticagrelor, with no significant differences in bleeding complications.
Answers are grounded in this paper and cite their sources.
Clopidogrel was associated with higher mortality in this STEMI cohort; leaves open optimal P2Y12 selection in primary PCI.
BACKGROUND/AIM: Coronavirus Disease 2019 (COVID-19) is characterized by an increased risk of thrombotic and hemorrhagic events resulting from endothelial dysfunction. In patients with ST-elevation myocardial infarction (STEMI), the dual antiplatelet therapy used to reduce mortality may increase the risk of bleeding. The study aimed to compare the efficacy and safety profiles of P2Y12 inhibitors used during the COVID-19 era. MATERIALS AND METHODS: Three hundred and ninety patients who underwent primary percutaneous intervention for STEMI between January 1, 2020, and December 31, 2021, were included in this study, retrospectively. The patients were divided into groups according to their COVID-19 history and all-cause mortality, cardiac mortality, stent thrombosis, and bleeding complications during hospitalization and at one-year follow-up were compared. RESULTS: The mean age of the patients was 64.3 years and the mean follow-up period was 10.2 months; 80% of the patients were male and 44.6% had a history of COVID-19 infection. The in-hospital mortality rate was 11.3%. Cardiac mortality was significantly higher in the clopidogrel group compared to the other groups, regardless of COVID-19 history (21.9% in the clopidogrel group, 1.6% in the prasugrel group, and 6.7% in the ticagrelor group (p<0.001)). There was no significant difference between the groups in terms of bleeding complications and relation to COVID-19. CONCLUSION: In STEMI patients treated with different P2Y12 inhibitors, there was no significant difference in mortality, bleeding, stroke, and thrombotic complications, regardless of the presence or absence of COVID-19 infection.
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Kaya et al. (2023) conducted a cohort in ST-Segment Elevation Myocardial Infarction (STEMI) (n=390). P2Y12 inhibitors (Clopidogrel, Ticagrelor, Prasugrel) vs. Compared to each other was evaluated on In-hospital cardiovascular mortality (p=<0.001). In STEMI patients treated during the COVID-19 pandemic, in-hospital cardiac mortality was significantly higher with clopidogrel (21.9%) compared to ticagrelor (6.7%) and prasugrel (1.6%).
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