![Sample our Medicine, Dentistry, Nursing & Allied Health journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5944/TOC-Subject-Sample-2021-Medicine-Dentistry-Nursing-Allied-Health.jpg"})
Abstract
Background
The concept of early administration of P2Y12 inhibitor in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) is widely accepted, but whether prehospital administration results in greater coronary reperfusion remains unclear. Our study aims to analyze the benefit and safety of prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor administration.
Method
Three databases (PubMed, EMBASE, and Cochrane Library) were searched from database inception to June 2023. We included all types of studies except for conference publications, abstract presentations, reviews, and case reports. The primary outcomes were pre-PCI TIMI flow grade 2–3 (TIMI = Thrombolysis in Myocardial Infarction) and major bleeding. The secondary outcomes included post-PCI TIMI flow grade 2–3, major adverse cardiac events (MACE), recurrent myocardial infarction (MI), and short-term (30-day) mortality.
Result
Eight individual studies with a total of 10823 patients were included in our meta-analysis. Compared with in-hospital P2Y12 inhibitor, prehospital P2Y12 inhibitor were associated with significantly higher rates of pre-PCI TIMI flow grade 2–3 (OR 1.32, 95% CI: 1.09–1.61, p = 0.005) and post-PCI TIMI flow grade 2–3 (OR 1.43, 95% CI: 1.04–1.97, p = 0.03), and a significantly lower risk of recurrent MI (OR 0.69, 95% CI: 0.49–0.96, p = 0.03). There were no significant difference in the risk of major bleeding (OR 1.00, 95% CI: 0.75–1.32, p = 0.98), MACE (OR 0.94, 95% CI: 0.70–1.25, p = 0.65), or short-term mortality (OR 0.87, 95% CI: 0.50–1.51, p = 0.61).
Conclusion
Prehospital P2Y12 inhibitor compared to in-hospital P2Y12 inhibitor is associated with a significantly higher rate of pre-PCI and post-PCI TIMI flow grade 2–3, a reduced risk of recurrent MI, and no increase in major bleeding in STEMI patients undergoing primary PCI.
Author Contributions
Yung-Hua Chou, Cheng-Chieh Huang, and Chia-Kai Chang are co-first authors of this study. Yan-Ren Lin designed this study. Yung-Hua Chou, Cheng-Chieh Huang, and Chia-Kai Chang searched the articles and assessed the quality of the included articles. Yung-Hua Chou, Jing-Lan Huang and Bo-Han Jang extracted data. Tsung-Han Lee and Kun-Te Lin performed statistical analyses, and interpreted the data under Yan-Ren Lin’s supervision. The manuscript was mainly written by Cheng-Chieh Huang and Chia-Kai Chang. Bo-Han Jang, Jing-Lan Huang, Wen-Liang Chen, and Chu-Chung Chou helped with the revision of the manuscript. All authors read and approved the final manuscript.
Disclosure Statement
No potential conflict of interest was reported by the author(s).
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Correction Statement
This article has been corrected with minor changes. These changes do not impact the academic content of the article.