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February 8, 2026European Heart Journal

Oral P2Y12 pre-treatment in AMI-CS is associated with ~48% higher major bleeding risk without reducing MACE.

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Why the study?

Data were lacking regarding the efficacy and safety of pre-treatment with P2Y12 inhibitors in patients with acute myocardial infarction complicated by cardiogenic shock.

Does pre-treatment with an oral loading dose of a P2Y12 inhibitor reduce MACE or increase major bleeding in patients with acute myocardial infarction complicated with cardiogenic shock?

Population

421 consecutive patients with AMI-CS admitted for coronary angiography within 24 hours

Comparison

Pre-treatment with oral P2Y12 inhibitor loading dose vs no pre-treatment

Design

Cohort study with inverse probability weighting analysis

Follow-up

30 days

Key result

Pre-treatment with oral P2Y12 inhibitors in AMI-CS patients increased major bleeding risk by 48% (wHR 1.48) without reducing 30-day major adverse cardiovascular events.

Authors

AEAnthony ElhadadDSDavid SulmanNPNiki Procopi

Discussion

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Overview

Pre-treatment was associated with higher bleeding without MACE benefit in AMI-CS; leaves open need for randomized trials before changing practice.

Key Points

  • The study aims to assess the efficacy and safety of pre-treatment with P2Y12 inhibitors in acute myocardial infarction complicated by cardiogenic shock.
  • Analyzed data from the ACTION-SHOCK cohort of patients hospitalized with AMI-CS from 2012 to 2023.
  • Included patients who underwent coronary angiography within 24 hours of admission.
  • Defined pre-treatment by administering an oral loading dose of a P2Y12 inhibitor before angiography.
  • Evaluated associations between pre-treatment and major adverse cardiovascular events (MACE) and major bleeding using an Inverse Probability Weighting approach.
  • 53.2% of patients received pre-treatment with a P2Y12 inhibitor.
  • No significant association found between pre-treatment and MACE at 30 days (42.1% vs 38.8%).
  • Pre-treatment was associated with a significantly higher risk of major bleeding (42.2% vs 32.3%), with a hazard ratio of 1.48.

Structured PICO

Does pre-treatment with an oral loading dose of a P2Y12 inhibitor reduce MACE or increase major bleeding in patients with acute myocardial infarction complicated with cardiogenic shock?

P
Population
421 patients with acute myocardial infarction complicated with cardiogenic shock (AMI-CS) admitted for coronary angiography within 24 hours of admission (ACTION-SHOCK cohort, 2012-2023).
I
Intervention
Pre-treatment with an oral loading dose of a P2Y12 inhibitor before coronary angiography.
C
Comparator
No pre-treatment with a P2Y12 inhibitor before coronary angiography.
O
Outcome
Composite of major adverse cardiovascular events (MACE: all-cause death, ischemic stroke, myocardial infarction, or stent thrombosis) at 30 days after admission.composite

Pre-treatment with oral P2Y12 inhibitors before angiography in patients with AMI and cardiogenic shock increases the risk of major bleeding without reducing 30-day major adverse cardiovascular events.

Cite This Study

Elhadad et al. (2025) studied this question. Pre-treatment with oral P2Y12 inhibitors in AMI-CS patients increased major bleeding risk by 48% (wHR 1.48) without reducing 30-day major adverse cardiovascular events.

synapsesocial.com/papers/698828850fc35cd7a88481adhttps://doi.org/10.1093/eurheartj/ehaf784.4278
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