Data presented at the 66th Annual Scientific Session & Expo of the American College of Cardiology (ACC) March 17-19, 2017, in Washington DC, suggest that a longer time between P2Y12 inhibitor administration and primary percutaneous coronary intervention (pPCI) improves coronary reperfusion.
Oral P2Y12 inhibitors have improved angiographic results of pPCI and clinical prognosis, but the onset of action is impaired in patients with ST-segment elevation myocardical infarction (STEMI). Therefore, researchers from the University of Bari in Italy conducted an observational study to determine whether the benefit of P2Y12 inhibitor loading dose administration is time related. The study included 250 consecutive patients with STEMI addressed with pPCI in the study (65.5±12 years; 81.3% men; 33.5% with diabetes).
The patients were divided into 3 groups depending upon the time interval from P2Y12 inhibitor loading dose administration to pPCI. The first group included patients receiving a P2Y12 inhibitor loading dose at least 60 minutes before pPCI, the second group included patients within 60 minutes before pPCI, and the third group included patients at the moment of pPCI after angiography. Two interventional cardiologists evaluated the Thrombolysis in Myocardial Infarction (TIMI) flow grade (TFG) of the culprit artery in the first angiogram immediately before and after pPCI.
The researchers observed a rate of 51.3% pre-pPCI TFG in the first group, 62.1% in the second group, and 83.2% in the third group. The post-pPCI TFG rate was 97.4% in the first group, 88.4% in the second group, and 82.2% in the third group.
“A longer time window between P2Y12 inhibitor administration and pPCI significantly improves coronary reperfusion in terms of both pre- and post-pPCI TFG,” the investigators concluded. “This finding supports the relevance of P2Y12-I LD [inhibitor low dose administration] as soon as possible at first medical contact.”
Pepe M, Masi F, Signore N, et al. Time related benefit of antiplatelet therapy on coronary reperfusion in ST-elevation myocardial infarction (STEMI) patients. Abstract 1296-303. Presented at: the 66th Annual Scientific Session & Expo of the American College of Cardiology. March 17-19, 2017; Washington, DC.