Effect of Pre PCI Antiplatelet Therapy in STEMI Patients Undergoing Primary PCI
Keywords:
STEMI, Primary PCI, Antiplatelet Therapy, Reperfusion, MortalityAbstract
Objective: To evaluate the effectiveness and safety of pre-percutaneous coronary intervention (PCI) antiplatelet therapy in patients with ST-elevation myocardial infarction (STEMI) undergoing primary PCI, specifically focusing on ST-segment resolution, mortality, and bleeding outcomes.
Methodology: A prospective, randomized clinical trial was conducted from January 2023 to December 2023 at Hayatabad Medical Complex, Peshawar, Pakistan. A total of 300 STEMI patients were randomized into two groups: one received pre-PCI antiplatelet therapy, while the control group received standard post-PCI therapy. Outcomes assessed included ST-segment resolution, 30-day mortality, and bleeding events. Statistical analysis was performed using chi-square tests and t-tests to determine differences in outcomes between groups, with significance set at p<0.05.
Results: Patients receiving pre-PCI antiplatelet therapy demonstrated a higher rate of ST-segment resolution (74.7%) compared to the control group (71.3%), though this difference was not statistically significant (p=0.603). A non-significant trend toward lower 30-day mortality was observed in the pre-PCI group (11.3% vs. 12.7%, p=0.859). Bleeding events were comparable between groups, with no significant increase in the pre-PCI therapy group (p=0.286).
Conclusion: Pre-PCI antiplatelet therapy shows promise in improving reperfusion outcomes without elevating bleeding risk in STEMI patients, suggesting it could be a valuable addition to standard care in similar clinical settings.
References
Gargiulo, G., Esposito, G., Cirillo, P., Nagler, M., Pietro Minuz, Campo, G., Gragnano, F., Negar Manavifar, Piccolo, R., Avvedimento, M., Tebaldi, M., Wahl, A., Hunziker, L., Billinger, M., Dik Heg, Windecker, S., & Valgimigli, M. (2020). Facilitation Through Aggrastat or Cangrelor Bolus and Infusion Over PrasugreL: a MUlticenter Randomized Open-label Trial in PatientS with ST-elevation Myocardial InFarction Referred for PrimAry PercutaneouS InTERvention (FABOLUS FASTER) Trial: Design and Rationale. Journal of Cardiovascular Translational Research, 14(1), 110–119. https://doi.org/10.1007/s12265-020-09969-4
You, J., Li, H., Guo, W., Li, J., Gao, L., Wang, Y., Geng, L., Wang, X., Wan, Q., & Zhang, Q. (2020). Platelet function testing guided antiplatelet therapy reduces cardiovascular events in Chinese patients with ST‐segment elevation myocardial infarction undergoing percutaneous coronary intervention: The PATROL study. Catheterization and Cardiovascular Interventions, 95(S1), 598–605. https://doi.org/10.1002/ccd.28712
Presume, J., Gomes, D. A., Ferreira, J., Albuquerque, F., Almeida, M., Uva, M. S., Aguiar, C., & Mendes, M. (2023). Effectiveness and Safety of P2Y12 Inhibitor Pretreatment for Primary PCI in STEMI: Systematic Review and Meta-analysis. Journal of Cardiovascular Pharmacology, 82(4), 298–307. https://doi.org/10.1097/fjc.0000000000001460
Fabris, E., Korjian, S., Coller, B., ten Berg, J. M., Granger, C. B., Gibson, C. M., & van’t Hof, A. (2021). Pre-Hospital Antiplatelet Therapy for STEMI Patients Undergoing Primary Percutaneous Coronary Intervention: What We Know and What Lies Ahead. Thrombosis and Haemostasis, 121(12). https://doi.org/10.1055/a-1414-5009
Vlachojannis, G. J., Vogel, R. F., Wilschut, J. M., Lemmert, M. E., Delewi, R., Diletti, R., van Vliet, R., van der Waarden, N., Nuis, R.-J., Paradies, V., Alexopoulos, D., Zijlstra, F., Montalescot, G., Angiolillo, D. J., Krucoff, M. W., Van Mieghem, N. M., & Smits, P. C. (2020). COMPARison of pre-hospital CRUSHed vs. uncrushed Prasugrel tablets in patients with STEMI undergoing primary percutaneous coronary interventions: Rationale and design of the COMPARE CRUSH trial. American Heart Journal, 224, 10–16. https://doi.org/10.1016/j.ahj.2020.03.005
Liu, D., Li, Y., Z., Wu, H., Zhou, G., Yang, J., Yang J, et al., (2020). efficacy and safety of genotype-guided antiplatelet therapy versus standard treatment in 4,604 patients with cad after pci: a meta-analysis of randomized controlled trials. Pharmazie, 75, 651–5. https://doi.org/10.1691/ph.2020.0755
van’t Hof, A. W., ten Berg, J., Heestermans, T., Dill, T., Funck, R. C., van Werkum, W., Dambrink, J.-H. E., Suryapranata, H., van Houwelingen, G., Ottervanger, J. P., Stella, P., Giannitsis, E., & Hamm, C. (2008). Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. The Lancet, 372(9638), 537–546. https://doi.org/10.1016/s0140-6736(08)61235-0
Berger, J. S., Roe, M. T., Gibson, C. M., Kilaru, R., Green, C. L., Melton, L. G., Blankenship, J. C., Metzger, D. C., Granger, C. B., Gretler, D. D., Grines, C. L., Huber, K., Zeymer, U., Buszman, P., Harrington, R. A., & Armstrong, P. W. (2009). Safety and feasibility of adjunctive antiplatelet therapy with intravenous elinogrel, a direct-acting and reversible P2Y12 ADP-receptor antagonist, before primary percutaneous intervention in patients with ST-elevation myocardial infarction: The Early Rapid ReversAl of Platelet ThromboSis with Intravenous Elinogrel before PCI to Optimize REperfusion in Acute Myocardial Infarction (ERASE MI) pilot trial. American Heart Journal, 158(6), 998-1004.e1. https://doi.org/10.1016/j.ahj.2009.10.010
Turker, Y. (2015). Role of tirofiban with dual antiplatelet therapy in patients with STEMI undergoing primary PCI. The Anatolian Journal of Cardiology, 15(11), 956–958. https://doi.org/10.5152/anatoljcardiol.2015.6654
Abtan, J., & Steg, P. G. (2019). Pre-treatment with a P2Y12 antagonist before PCI in STEMI: why should we wait? European Heart Journal, 40(15), 1211–1213. https://doi.org/10.1093/eurheartj/ehz058
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