Fire Bureau of Changhua County Government, Changhua, Taiwan.
National Changhua University of Education, Changhua, Taiwan.
Prehosp Emerg Care. 2024;28(7):937-946. doi: 10.1080/10903127.2023.2284819. Epub 2023 Dec 19.
The concept of early administration of P2Y12 inhibitor in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is widely accepted, but whether prehospital administration results in greater coronary reperfusion remains unclear. Our study aims to analyze the benefit and safety of prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor administration.
Three databases (PubMed, EMBASE, and Cochrane Library) were searched from database inception to June 2023. We included all types of studies except for conference publications, abstract presentations, reviews, and case reports. The primary outcomes were pre-PCI TIMI flow grade 2-3 (TIMI = Thrombolysis in Myocardial Infarction) and major bleeding. The secondary outcomes included post-PCI TIMI flow grade 2-3, major adverse cardiac events (MACE), recurrent myocardial infarction (MI), and short-term (30-day) mortality.
Eight individual studies with a total of 10823 patients were included in our meta-analysis. Compared with in-hospital P2Y12 inhibitor, prehospital P2Y12 inhibitor were associated with significantly higher rates of pre-PCI TIMI flow grade 2-3 (OR 1.32, 95% CI: 1.09-1.61, = 0.005) and post-PCI TIMI flow grade 2-3 (OR 1.43, 95% CI: 1.04-1.97, = 0.03), and a significantly lower risk of recurrent MI (OR 0.69, 95% CI: 0.49-0.96, = 0.03). There were no significant difference in the risk of major bleeding (OR 1.00, 95% CI: 0.75-1.32, = 0.98), MACE (OR 0.94, 95% CI: 0.70-1.25, = 0.65), or short-term mortality (OR 0.87, 95% CI: 0.50-1.51, = 0.61).
Prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor is associated with a significantly higher rate of pre-PCI and post-PCI TIMI flow grade 2-3, a reduced risk of recurrent MI, and no increase in major bleeding in STEMI patients undergoing primary PCI.
在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，早期应用 P2Y12 抑制剂的概念已被广泛接受，但院前应用是否能带来更大的冠状动脉再灌注仍不清楚。我们的研究旨在分析与院内 P2Y12 抑制剂相比，院前 P2Y12 抑制剂的获益和安全性。
从数据库建立之初到 2023 年 6 月，我们检索了三个数据库（PubMed、EMBASE 和 Cochrane Library）。我们纳入了除会议出版物、摘要演示、综述和病例报告以外的所有类型的研究。主要结局是 PCI 前 TIMI 血流分级 2-3 级（TIMI=心肌梗死溶栓）和主要出血。次要结局包括 PCI 后 TIMI 血流分级 2-3 级、主要不良心脏事件（MACE）、复发性心肌梗死（MI）和短期（30 天）死亡率。
共有 8 项个体研究，共纳入 10823 例患者，纳入我们的荟萃分析。与院内 P2Y12 抑制剂相比，院前 P2Y12 抑制剂与 PCI 前 TIMI 血流分级 2-3 级（OR 1.32，95%CI：1.09-1.61， = 0.005）和 PCI 后 TIMI 血流分级 2-3 级（OR 1.43，95%CI：1.04-1.97， = 0.03）的发生率显著增加相关，而复发性 MI 的风险显著降低（OR 0.69，95%CI：0.49-0.96， = 0.03）。主要出血（OR 1.00，95%CI：0.75-1.32， = 0.98）、MACE（OR 0.94，95%CI：0.70-1.25， = 0.65）或短期死亡率（OR 0.87，95%CI：0.50-1.51， = 0.61）无显著差异。
与院内 P2Y12 抑制剂相比，院前 P2Y12 抑制剂与 STEMI 患者直接 PCI 前和后 TIMI 血流分级 2-3 级的发生率显著增加、复发性 MI 的风险降低、主要出血无增加有关。
