Naslov
EARLY PRELOADING WITH P2Y12 INHIBITORS IN PATIENTS PRESENTING WITH ACUTE CORONARY SYNDROMES WITHOUT PERSISTENT ST-SEGMENT ELEVATION

Autori
Marcelius, Bjornar

Vrsta, podvrsta i kategorija rada
Ocjenski radovi, diplomski rad

Fakultet
Medicinski fakultet

Mjesto
Split

Datum
16.09

Godina
2021

Stranica
60

Mentor
Borovac, Josip Anđelo

Ključne riječi
Acute coronary syndrome ; Non-ST Elevated Myocardial Infarction ; NSTE-ACS ; Unstable angina ; Preloading ; Loading ; P2Y12 ; Prasugrel ; Ticagrelor ; Clopidogrel ; Cangrelor ; Bleeding ; Ischemia ; NACE ; Net Adverse Clinical Events

Sažetak
Objectives: The aims of this study were to investigate the impact of early P2Y12 inhibitor preloading (pretreatment) vs. no preloading on short-term clinical outcomes in patients with acute coronary syndromes without persistent ST- segment elevation (NSTE-ACS). Patients and methods: Meta-analysis and quantitative synthesis were performed by including five randomized controlled trials (RCTs) that examined P2Y12 preloading in NSTE-ACS patients. Primary outcomes of interest were composite endpoints of ischemia, bleeding, and net adverse clinical events (NACE) at 30 days. Risk ratio (RR) with 95% confidence intervals (95% CI) was used as the main summary measure while a random-effects model with the Mantel-Haenszel method was used to populate results of meta- analysis. Results: A total of 5 RCTs enrolling 22207 patients with NSTE-ACS contributed to observed effect estimates. Four trials were at low risk of bias (RoB) while one trial had some concerns regarding RoB. Trials dominantly enrolled men and acetylsalicylic acid was used concomitantly as a second antiplatelet agent. Early P2Y12 preloading was similar to no preloading strategy among NSTE-ACS patients concerning the risk of ischemic events at 30 days (RR 0.93, 95% CI 0.79- 1.09, P=0.350 ; low heterogeneity detected – I2=41%). On the other hand, the P2Y12 preloading strategy was associated with a significant 65% increase in the relative risk of a bleeding event at 30 days, compared to no P2Y12 preloading strategy (RR 1.65, 95% CI 1.47-1.85, P<0.001 ; no heterogeneity detected – I2=0%). Finally, P2Y12 preloading was associated with a significant 19% increase in the relative risk of NACE at 30 days (RR 1.19, 95% CI 1.11-1.29, P<0.001 ; no heterogeneity detected – I2=0%). Conclusion: Early P2Y12 inhibitor preloading in NSTE-ACS did not improve ischemic outcomes and significantly increased the risk of bleeding at 30 days, compared to a treatment strategy that did not use preloading. Similarly, early P2Y12 preloading was significantly associated with a higher risk of NACE at 30 days. Taken together, obtained data suggest that an early preloading strategy with P2Y12 inhibitors should be avoided in NSTE-ACS.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

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