The efficacy of early versus delayed P2Y12 inhibition in percutaneous coronary intervention for ST-elevation myocardial infarction: a systematic review and meta-analysis.


Journal Article

AIMS: The aim of this meta-analysis was to compare the benefit of "early" vs. "delayed" P2Y12 inhibition in patients undergoing percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS: We conducted a meta-analysis including seven randomised controlled trials (RCTs) which compared early vs. delayed P2Y12inhibition in STEMI patients scheduled for PCI, providing data on major adverse cardiac events (MACE), all-cause death, and major bleeding. The primary endpoint was MACE. Secondary endpoints included stent thrombosis and the use of GP IIb/IIIa inhibitors (GPI). All endpoints were analysed at the shortest follow-up available. A total of 9,648 patients were included ("early"=4,792, "delayed"=4,856). "Early" P2Y12 inhibition was associated with a significant reduction in MACE rate (OR 0.73, 95% CI: 0.61-0.88, p=0.0008), myocardial infarction (OR 0.71, 95% CI: 0.57-0.90, p=0.004), bail-out GPI use (OR 0.87, 95% CI: 0.75-1.00, p=0.04) and improved coronary reperfusion before PCI (OR for Thrombolysis In Myocardial Infarction [TIMI] flow grade 2-3=1.12, 95% CI: 1.00-1.26, p=0.04). Major bleeding was not increased (OR 0.87, 95% CI: 0.62-1.21, p=0.41). CONCLUSIONS: A strategy of early effective P2Y12 inhibition in PCI of STEMI appears to improve coronary reperfusion before PCI, and reduce MACE, MI and bail-out GPI use without increase of major bleeding.

Full Text

Duke Authors

Cited Authors

  • Bellemain-Appaix, A; Bégué, C; Bhatt, DL; Ducci, K; Harrington, RA; Roe, M; Wiviott, SD; Cucherat, M; Silvain, J; Collet, J-P; Bernasconi, F; Montalescot, G

Published Date

  • May 20, 2018

Published In

Volume / Issue

  • 14 / 1

Start / End Page

  • 78 - 85

PubMed ID

  • 29469030

Pubmed Central ID

  • 29469030

Electronic International Standard Serial Number (EISSN)

  • 1969-6213

Digital Object Identifier (DOI)

  • 10.4244/EIJ-D-17-00852


  • eng

Conference Location

  • France