Kubica Jacek, Adamski Piotr, Badariene Jolita, Bonaca Marc, Buszman Piotr, Gabulova Rahima, Gajda Robert, Geisler Tobias, Gil Robert, Gorog Diana A, Gurbel Paul A, Hajdukiewicz Tomasz, Hudzik Bartosz, James Stefan, Jeong Young-Hoon, Kern Adam, Kochman Wacław, Kubica Aldona, Kuliczkowski Wiktor, Magielski Przemysław, Niezgoda Piotr, Ostrowska Małgorzata, Raggi Paolo, Rahimov Uzeyir, Skonieczny Grzegorz, Siller-Matula Jolanta M, Specchia Giuseppe, Szarpak Łukasz, Szymański Paweł, Tantry Udaya, Umińska Julia, Navarese Eliano Pio
Department of Cardiology and Internal Medicine, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Cardiol J. 2025;32(2):189-194. doi: 10.5603/cj.99973. Epub 2025 Mar 20.
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.
2023年欧洲心脏病学会（ESC）指南改变了先前推荐的ST段抬高型心肌梗死（STEMI）患者早期治疗策略。对于接受直接经皮冠状动脉介入治疗（PCI）策略的患者，可考虑使用P2Y12受体抑制剂进行预处理（IIb类，证据水平B）。然而，现有科学证据支持采用个性化方法，根据阿片类药物的联合使用情况区分口服P2Y12受体抑制剂预处理的适应证。我们认为，在未接受阿片类药物治疗的直接PCI患者中，应采用口服P2Y12受体抑制剂进行预处理，而在接受阿片类药物治疗的直接PCI患者中，应考虑使用口服P2Y12受体抑制剂进行预处理。
