P2Y12 inhibitor pretreatment in STEMI patients increased baseline TIMI 3 flow from 4.2% to 6.6% but was linked to higher in-hospital mortality (4.5% vs 3.1%).
Does P2Y12 inhibitor pretreatment improve baseline TIMI flow and reduce in-hospital mortality in STEMI patients undergoing primary PCI?
Prehospital administration of P2Y12 inhibitors in STEMI patients improves baseline coronary flow, particularly in early presenters, but does not independently reduce short-term mortality.
Absolute Event Rate: 0% vs 0%
Abstract Background Pretreatment with oral P2Y12 inhibitors is a standard practice for patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). Current European guidelines suggest that pretreatment may be considered in STEMI patients undergoing primary PCI (Class IIb, Level of Evidence B). However, this recommendation is supported by limited evidence. Purpose To assess the impact of P2Y12 inhibitor pretreatment on baseline Thrombolysis in Myocardial Infarction (TIMI) flow and in-hospital mortality in patients with STEMI. Methods This retrospective, observational study analyzed 6,239 STEMI patients treated at a single PCI center over a 10-year period. Only patients experiencing first STEMI, with symptom onset 12 hours and scheduled for immediate primary PCI were included. Results The cohort comprised 6,239 patients with a median age of 62 years, of whom 32% were female and 16.9% had diabetes mellitus. P2Y12 inhibitor pretreatment was administered to 5,168 patients (82.8%, with potent P2Y12 inhibitors accounting for 63.6%), while 1,071 patients (17.2%) did not receive pretreatment. Patients who received P2Y12 inhibitor pretreatment had a significantly higher rate of TIMI 3 flow at baseline coronary angiography compared to those without pretreatment (6.6% vs. 4.2%, p = 0.003). Although the rehospitalization rate was higher in patients without pretreatment, the difference was not statistically significant (1.5% vs. 2.0%, p = 0.213). However, in-hospital mortality was significantly higher in the pretreatment group (4.5% vs. 3.1%, p = 0.031), as was 30-day mortality (5.4% vs. 3.8%, p = 0.039). In patients presenting within 2 hours of symptom onset, P2Y12 inhibitor pretreatment was associated with an improved rate of TIMI 3 flow (7.1% vs. 3.3%, p = 0.019) and had no impact on mortality (3.1% vs. 3.0%, p = 1.0). In contrast, among patients presenting 2 hours after symptom onset, pretreatment did not significantly influence TIMI 3 flow (5.8% vs. 4.2%, p = 0.209) but was associated with a higher mortality rate (4.1% vs. 1.6%, p = 0.012). Univariate and multivariate regression analyses were conducted to identify predictors of in-hospital mortality. Independent predictors included age (HR 1.061, 95% CI 1.039–1.082, p 0.0001), diabetes mellitus (HR 1.924, 95% CI 1.200–3.085, p = 0.007), Killip class at admission (HR 3.453, 95% CI 2.823–4.224, p 0.0001), and anterior STEMI (HR 1.787, 95% CI 1.168–2.732, p = 0.007). Conclusion Prehospital administration of P2Y12 inhibitors in STEMI patients may enhance baseline TIMI flow, particularly in those presenting early after symptom onset. However, in-hospital mortality appears to be primarily influenced by established risk factors such as advanced age, diabetes mellitus, higher Killip class, and anterior STEMI, rather than P2Y12 inhibitor pretreatment.
Kovacevic et al. (Sat,) reported a other. P2Y12 inhibitor pretreatment in STEMI patients increased baseline TIMI 3 flow from 4.2% to 6.6% but was linked to higher in-hospital mortality (4.5% vs 3.1%).