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Pretreatment with P2Y12 receptor antagonists in ST-elevation myocardial infarction: a report from the Swedish Coronary Angiography and Angioplasty Registry.

Artikel i vetenskaplig tidskrift
Författare Björn Redfors
Inger Haraldsson
Oskar Angerås
Jacob Odenstedt
Dan Ioanes
Petur Petursson
Sebastian Völz
Per Albertsson
Truls Råmunddal
Jonas Persson
Sasha Koul
David Erlinge
Elmir Omerovic
Publicerad i European heart journal
Volym 40
Nummer/häfte 15
Sidor 1202-10
ISSN 1522-9645
Publiceringsår 2019
Publicerad vid
Sidor 1202-10
Språk en
Länkar dx.doi.org/10.1093/eurheartj/ehz069
www.ncbi.nlm.nih.gov/entrez/query.f...
Ämneskategorier Kardiovaskulär medicin

Sammanfattning

Pretreatment of patients with ST-elevation myocardial infarction (STEMI) with P2Y12 receptor antagonists is supported by guidelines and is a common practice despite the lack of definite evidence for its benefit.Using data from the Swedish Coronary Angiography and Angioplasty Registry on procedures between 2005 and 2016, we stratified all patients who underwent primary percutaneous coronary intervention due to STEMI in Sweden by whether or not they were pretreated with P2Y12 receptor antagonists. We investigated associations between pretreatment with P2Y12 receptor antagonists and the risk of adverse outcomes using propensity score-adjusted mixed-effects logistic regression, which accounted for clustering of patients within hospitals. The primary endpoint was all-cause death within 30 days. Secondary endpoints were infarct-related artery (IRA) occlusion, 30-day stent thrombosis, in-hospital bleeding, neurological complications, and cardiogenic shock. In total, 44 804 patients were included. They were treated with clopidogrel (N = 26 136, 58.3%), ticagrelor (N = 15 792, 35.3%), or prasugrel (N = 2352, 5.3%); 37 840 (84.5%) were pretreated, and 30 387 (67.8%) had IRA occlusion. At 30 days, there were 2488 (5.6%) deaths and 267 (0.6%) stent thrombosis. Pretreatment was not associated with better survival at 30 days [odds ratio (OR) 1.08, 95% confidence interval (CI) 0.95-1.24; P = 0.313], reduced IRA occlusion (OR 0.98, 95% CI 0.92-1.05; P = 0.608), decreased stent thrombosis (OR 0.99, 95% CI 0.69-1.43; P = 0.932), higher risk of in-hospital bleeding (OR 1.05, 95% CI 0.89-1.26; P = 0.526), or neurological complications (OR 0.66, 0.72, 95% CI 0.43-1.21; P = 0.210).Pretreatment of STEMI patients with P2Y12 receptor antagonists was not associated with improved clinical outcomes.

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