Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Medicine II, Kansai Medical University, Hirakata, Japan.
JACC Cardiovasc Interv. 2024 Jan 8;17(1):17-28. doi: 10.1016/j.jcin.2023.10.064.
Evidence to support immediate P2Y inhibitor loading in ST-segment elevation myocardial infarction (STEMI) is limited.
This study sought to compare outcomes of STEMI patients receiving immediate or delayed P2Y inhibitor treatment.
Using data from the prospective Bern-PCI registry between 2016 and 2020, we stratified STEMI patients undergoing percutaneous coronary intervention according to time periods with different institutional recommendations regarding P2Y inhibitor pretreatment. In cohort 1 (October 2016-September 2018), immediate P2Y inhibitor treatment was recommended. In cohort 2 (October 2018-September 2020), P2Y inhibitor treatment was recommended after coronary anatomy was confirmed. The primary endpoint was a composite of major adverse cardiac or cerebrovascular events (MACCEs) defined as all-cause death, recurrent myocardial infarction, stroke, or definite stent thrombosis at 30 days. Sensitivity analysis included only patients in whom these recommendations were followed.
Cohort 1 included 1,116 patients; pretreatment was actually given in 708 (63.4%). Cohort 2 included 847 patients; pretreatment was withheld in 798 (94.2%). The mean age was 65 ± 13 years, and 24% were female. Baseline characteristics were well-balanced between groups. The median difference for P2Y loading to angiography was 52 minutes between cohort 1 and 2 and 100 minutes between patients receiving vs not receiving pretreatment. Rates of MACCEs were similar between cohort 1 and cohort 2 (10.1% vs 8.1%; adjusted HR: 0.91; 95% CI: 0.65-1.28; P = 0.59) and between patients receiving vs not receiving pretreatment (7.1% vs 8.4%; adjusted HR: 1.17; 95% CI: 0.78-1.74; P = 0.45).
In this cohort study of patients with STEMI undergoing primary percutaneous coronary intervention, P2Y inhibitor pretreatment was not associated with improved MACCEs.
目前支持 ST 段抬高型心肌梗死（STEMI）患者即刻给予 P2Y 抑制剂负荷剂量的证据有限。
本研究旨在比较即刻和延迟给予 P2Y 抑制剂治疗的 STEMI 患者的结局。
使用 2016 年至 2020 年前瞻性 Bern-PCI 注册研究的数据，我们根据不同机构关于 P2Y 抑制剂预处理的建议时间段，对接受经皮冠状动脉介入治疗的 STEMI 患者进行分层。在队列 1（2016 年 10 月至 2018 年 9 月）中，推荐即刻给予 P2Y 抑制剂治疗。在队列 2（2018 年 10 月至 2020 年 9 月）中，建议在确认冠状动脉解剖结构后给予 P2Y 抑制剂治疗。主要终点是 30 天内发生的主要不良心脏或脑血管事件（MACCEs）的复合终点，定义为全因死亡、再发心肌梗死、卒中和明确的支架血栓形成。敏感性分析仅包括遵循这些建议的患者。
队列 1 纳入 1116 例患者；实际给予预处理的有 708 例（63.4%）。队列 2 纳入 847 例患者；有 798 例（94.2%）未给予预处理。平均年龄为 65±13 岁，24%为女性。两组间基线特征均衡。队列 1 和队列 2 之间 P2Y 负荷至血管造影的中位时间差为 52 分钟，接受与不接受预处理的患者之间为 100 分钟。队列 1 和队列 2 之间的 MACCEs 发生率相似（10.1%比 8.1%；调整后的 HR：0.91；95%CI：0.65-1.28；P=0.59），以及接受与不接受预处理的患者之间（7.1%比 8.4%；调整后的 HR：1.17；95%CI：0.78-1.74；P=0.45）。
在这项接受直接经皮冠状动脉介入治疗的 STEMI 患者的队列研究中，P2Y 抑制剂预处理并未改善 MACCEs。
