Pre-treatment with a P2Y12 inhibitor oral load in AMI-CS patients showed no benefit on 30-day MACE (wHR 1.11; 95% CI 0.82-1.50) but was associated with an increased risk of major bleeding.
Cohort (n=421)
Does pre-treatment with an oral loading dose of a P2Y12 inhibitor reduce MACE in patients with acute myocardial infarction complicated with cardiogenic shock?
Pre-treatment with oral P2Y12 inhibitors in AMI patients with cardiogenic shock is associated with increased major bleeding without cardiovascular benefit.
Hazard Ratio: 1.11 (95% CI 0.82–1.5)
Absolute Event Rate: 42.1% vs 38.8%
BACKGROUND AND AIMS: There are currently no data regarding pre-treatment with P2Y12 inhibitors in patients with acute myocardial infarction complicated with cardiogenic shock (AMI-CS). This study investigates the effectiveness and safety of pre-treatment with P2Y12 inhibitors in patients with AMI-CS. METHODS AND RESULTS: Using the ACTION-SHOCK cohort, we included consecutive patients hospitalized between 2012 and 2023 with AMI-CS admitted for coronary angiography within 24 h of admission. Pretreatment was defined by the administration before angiography of an oral loading dose of a P2Y12 inhibitor. We evaluated the association between pretreatment 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, ischaemic stroke, myocardial infarction, or stent thrombosis. Major bleeding was defined by Bleeding Academic Research Consortium grade 3, 4, or 5. Among the 421 patients with AMI-CS admitted to the catheterization laboratory within 24 h 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 bleeding (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.
Elhadad et al. (Tue,) conducted a cohort in Acute myocardial infarction complicated with cardiogenic shock (AMI-CS) (n=421). Pre-treatment with P2Y12 inhibitors vs. No pre-treatment was evaluated on Major adverse cardiovascular events (MACE) at 30 days (wHR 1.11, 95% CI 0.82-1.50). Pre-treatment with a P2Y12 inhibitor oral load in AMI-CS patients showed no benefit on 30-day MACE (wHR 1.11; 95% CI 0.82-1.50) but was associated with an increased risk of major bleeding.
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