Abstract 11149: Pretreatment With P2Y12 Inhibitors in ST-Elevation Myocardial Infarction & Systematic Review and Meta-Analysis

Background: the practice of pretreatment with oral P 2 Y 12 inhibitors in ST-Elevation Myocardial Infarction (STEMI) remains common; however, its association with improved cardiovascular outcomes is unclear, since no large RCT has addressed this issue. Hypothesis: We aimed to evaluate the association of oral P2Y12 inhibitor pretreatment in STEMI patients with cardiovascular and bleeding outcomes. Methods: PubMed, MEDLINE, Embase, Cochrane, Scopus, Web of Science were systematically searched for studies that compared pretreatment with P 2 Y 12 versus no pretreatment in STEMI, and reported efficacy and safety outcomes. A meta-analysis using a fixed and random effects model was used to calculated outcomes of interest. Heterogeneity was assessed with I 2 statistics. Results: A total of 3 RCTs and 14 observational studies assigning 91,771 patients to either pretreatment (65,598 patients) or no pretreatment (26,171 patients) were included. Follow-up ranged from 7 days to 19 months. The P 2 Y 12 inhibitors included clopidogrel, prasugrel and ticagrelor. At 30 days, P 2 Y 12 pretreatment was associate with lower 30-day mortality (risk ratio [RR], 0.71; 95% CI, 0.56-0.91; p=0.006; I 2 =75%), stent thrombosis (RR, 0.33; 95% CI, 0.12-0.95; p=0.04; I 2 =83%), and major bleeding (RR, 0.81; 95% CI, 0.74-0.90; p<0.0001; I 2 =0%). No difference in the incidence of 30-day myocardial infarction (MI), target vessel revascularization (TVR), MACE (death/MI/TVR), stroke, pre-PCI TIMI 0 flow, and post-PCI TIMI 0-2 flow was observed. Subgroup analysis including only randomized studies indicated no difference in all-cause mortality between groups (RR, 1.49; 95% CI, 0.89-2.52; p=0.13; I 2 =38%). Conclusion: In this study, pretreatment with oral P2Y12 inhibitors among patients with STEMI before cath lab, compared with treatment once coronary anatomy is known, was associated with decreased all-cause mortality and bleeding risk.