Abstract：
The optimal timing of P2Y12 inhibitor administration in patients with ST-segment elevation myocardial infarction (STEMI) has not been completely elucidating.
This analysis from a prospective multicenter registry sought to assess the safety and effectiveness of P2Y12 inhibitor pretreatment in patients transferred for primary percutaneous coronary intervention (PCI) within a regional STEMI network.
Pretreatment was defined as P2Y12 inhibitor administration before coronary angiography. Endpoints were major adverse cardiac events (MACE), major bleeding, and net adverse clinical events, a composite of MACE or major bleeding, within 30 days of index admission. Association of P2Y12 inhibitor pretreatment with outcomes was modeled using doubly robust weighted estimators based on propensity score analysis.
Of 1,624 patients included, 1,033 received P2Y12 inhibitors before angiography and 591 in the catheterization laboratory (cath lab). The non-pretreated cohort more often had history of coronary artery disease and were more likely to receive antiplatelet therapy before the index admission. After adjustment for confounding and dependent censoring, pretreatment with P2Y12 inhibitors predicted lower risk of MACE (adjusted HR: 0.53; 95% CI: 0.37-0.76), without increasing bleeding risk (adjusted HR: 0.62; 95% CI: 0.36-1.05), resulting in superior net clinical benefit (adjusted HR: 0.47; 95% CI: 0.26-0.86) compared with in-cath lab administration of P2Y12 inhibitors. There was a significant treatment-by-time interaction for MACE risk, whereby the observed benefits of pretreatment only became apparent when time between P2Y12 inhibitor administration and PCI was longer than 80 minutes.
In contemporary patients with STEMI transferred for primary PCI, pretreatment with P2Y12 inhibitors was associated with a significant time-dependent reduction of 30-day MACE without increasing bleeding risk.
This analysis from a prospective multicenter registry sought to assess the safety and effectiveness of P2Y12 inhibitor pretreatment in patients transferred for primary percutaneous coronary intervention (PCI) within a regional STEMI network.
Pretreatment was defined as P2Y12 inhibitor administration before coronary angiography. Endpoints were major adverse cardiac events (MACE), major bleeding, and net adverse clinical events, a composite of MACE or major bleeding, within 30 days of index admission. Association of P2Y12 inhibitor pretreatment with outcomes was modeled using doubly robust weighted estimators based on propensity score analysis.
Of 1,624 patients included, 1,033 received P2Y12 inhibitors before angiography and 591 in the catheterization laboratory (cath lab). The non-pretreated cohort more often had history of coronary artery disease and were more likely to receive antiplatelet therapy before the index admission. After adjustment for confounding and dependent censoring, pretreatment with P2Y12 inhibitors predicted lower risk of MACE (adjusted HR: 0.53; 95% CI: 0.37-0.76), without increasing bleeding risk (adjusted HR: 0.62; 95% CI: 0.36-1.05), resulting in superior net clinical benefit (adjusted HR: 0.47; 95% CI: 0.26-0.86) compared with in-cath lab administration of P2Y12 inhibitors. There was a significant treatment-by-time interaction for MACE risk, whereby the observed benefits of pretreatment only became apparent when time between P2Y12 inhibitor administration and PCI was longer than 80 minutes.
In contemporary patients with STEMI transferred for primary PCI, pretreatment with P2Y12 inhibitors was associated with a significant time-dependent reduction of 30-day MACE without increasing bleeding risk.
摘要：
背景：ST段抬高型心肌梗死（STEMI）患者使用P2Y12抑制剂的最佳时机尚未完全阐明。
目的：这项来自前瞻性多中心注册中心的分析旨在评估P2Y12抑制剂预处理在区域性STEMI网络中接受直接经皮冠状动脉介入治疗（PCI）的患者中的安全性和有效性。
方法：预处理定义为在冠状动脉造影前给予P2Y12抑制剂。终点是主要不良心脏事件（MACE），大出血,和净不良临床事件，MACE或大出血的复合物，在索引录取后的30天内。使用基于倾向评分分析的双重稳健加权估计器对P2Y12抑制剂预处理与结果的关联进行建模。
结果：包括1,624名患者，1,033人在血管造影前接受了P2Y12抑制剂，591人在导管插入实验室（cath实验室）接受了P2Y12抑制剂。未经预处理的队列更经常有冠状动脉疾病病史，并且在入院前更有可能接受抗血小板治疗。在对混杂和依赖审查进行调整后，P2Y12抑制剂预处理预测MACE风险较低(调整后HR:0.53;95%CI:0.37-0.76),不增加出血风险（调整后HR：0.62；95％CI：0.36-1.05），与静脉实验室内给予P2Y12抑制剂相比,产生了优异的净临床获益(校正后HR:0.47;95%CI:0.26-0.86).MACE风险存在显著的治疗时间交互作用，由此观察到的预处理的益处仅在P2Y12抑制剂给药和PCI之间的时间超过80分钟时才变得明显。
结论：在接受直接PCI治疗的当代STEMI患者中，P2Y12抑制剂预处理与30天MACE的时间依赖性显著降低相关，而不增加出血风险。
目的：这项来自前瞻性多中心注册中心的分析旨在评估P2Y12抑制剂预处理在区域性STEMI网络中接受直接经皮冠状动脉介入治疗（PCI）的患者中的安全性和有效性。
方法：预处理定义为在冠状动脉造影前给予P2Y12抑制剂。终点是主要不良心脏事件（MACE），大出血,和净不良临床事件，MACE或大出血的复合物，在索引录取后的30天内。使用基于倾向评分分析的双重稳健加权估计器对P2Y12抑制剂预处理与结果的关联进行建模。
结果：包括1,624名患者，1,033人在血管造影前接受了P2Y12抑制剂，591人在导管插入实验室（cath实验室）接受了P2Y12抑制剂。未经预处理的队列更经常有冠状动脉疾病病史，并且在入院前更有可能接受抗血小板治疗。在对混杂和依赖审查进行调整后，P2Y12抑制剂预处理预测MACE风险较低(调整后HR:0.53;95%CI:0.37-0.76),不增加出血风险（调整后HR：0.62；95％CI：0.36-1.05），与静脉实验室内给予P2Y12抑制剂相比,产生了优异的净临床获益(校正后HR:0.47;95%CI:0.26-0.86).MACE风险存在显著的治疗时间交互作用，由此观察到的预处理的益处仅在P2Y12抑制剂给药和PCI之间的时间超过80分钟时才变得明显。
结论：在接受直接PCI治疗的当代STEMI患者中，P2Y12抑制剂预处理与30天MACE的时间依赖性显著降低相关，而不增加出血风险。
