P2Y12 pretreatment in STEMI improved TIMI flow before and after PCI (100% TIMI III vs 80%, p=0.01) but did not significantly reduce thrombus burden or in-hospital mortality.
Does P2Y12 inhibitor pretreatment at first medical contact improve intracoronary thrombus burden and angiographic outcomes in patients with STEMI undergoing PCI?
In patients with STEMI, P2Y12 inhibitor pretreatment improves pre- and post-PCI coronary flow but does not significantly reduce angiographic thrombus burden or in-hospital mortality compared to cath-lab administration.
Absolute Event Rate: 0% vs 0%
Abstract Background The optimal timing of P2Y12 inhibitor administration in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) remains a subject of debate. Purpose This study aims to evaluate the impact of P2Y12 pre-treatment versus cath-lab administration on thrombus burden and angiographic outcomes. Methods We conducted a prospective observational study comparing patients with STEMI receiving P2Y12 inhibitor loading dose at first medical contact (pretreatment group) versus those receiving after the coronary anatomy was observed (cath-lab group). The primary outcome was intracoronary thrombus burden (TB), classified as small thrombus burden (STB; grade 0–3) or large thrombus burden (LTB; grade 4–5), following guidewire or small-diameter balloon passage. Secondary outcomes included initial Thrombolysis in Myocardial Infarction (TIMI) flow before and after PCI, and in-hospital mortality rates. Results A total of 79 patients (29 pretreatment vs 50 cath-lab) with STEMI were included in the analysis. The mean age was 64 ± 12 years (75.9% males). The median time from first medical contract to coronary angiography was 45 minutes. No difference in LTB was noted between the two treatment groups (pretreatment:58.6% vs cathlab:72%; p=0.223). Furthermore, initial TIMI flow was significantly worse in cath-lab treated patients (TIMI 0; 31% vs 58%; p=0.015). Interestingly TIMI III flow after PCI was achieved at 100% of pretreatment group compared to 80% in the cath-lab group (p=0.01). Importantly, no difference regarding in-hospital morality was observed between the two groups (0% vs 6%; p=0.179). Conclusion In patients with STEMI, TIMI flow was significantly better for both before and after PCI when a pretreatment with P2Y12 over cath-lab treatment was applied. However, pretreatment did not significantly reduce thrombus burden or in-hospital mortality compared to cath-lab administration. This finding suggests a potential early benefit in coronary perfusion with P2Y12 pre-treatment with unknown impact on long term outcomes.
Vythoulkas-Biotis et al. (Sat,) reported a other. P2Y12 pretreatment in STEMI improved TIMI flow before and after PCI (100% TIMI III vs 80%, p=0.01) but did not significantly reduce thrombus burden or in-hospital mortality.