Early treatment with inhibitors of P2Y12 receptor in patients with ST-segment elevation myocardial infarction - 2023 ESC recommendations and scientific evidence. Is clinical evidence sufficient to suggest a move towards precision medicine? The ELECTRA-SIRIO 2 investigators' viewpoint.

The 2023 ESC guidelines changed previously recommended a strategy of early treatment in patients with STEMI. Pre-treatment with a P2Y12 receptor inhibitor may be considered in patients undergoing a primary PCI strategy (Class IIb, Level of evidence B). However, the available scientific evidence justifies a personalized approach differentiating the indications for pre-treatment with oral P2Y12 receptor inhibitors depending on the concomitant administration of opioids. In our opinion, in patients undergoing primary PCI not treated with opioids, pre-treatment with an oral P2Y12 receptor inhibitor should be applied, while in patients undergoing primary PCI treated with opioids, pre-treatment with an oral P2Y12 receptor inhibitor should be considered.