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JACC Cardiovasc Interv. 2016 May 23;9(10):1036-46. doi: 10.1016/j.jcin.2016.02.013.

Optimal P2Y12 Inhibitor in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Network Meta-Analysis.

Author information

1
Department of Medicine/Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Department of Medicine/Cardiology, UCLA Medical Center, Los Angeles, California.
2
Department of Medicine/Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
3
Duke Clinical Research Institute, Durham, North Carolina.
4
Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
5
Department of Medicine/Cardiology, Mount Sinai Hospital, New York, New York.
6
Northwell Health, New York, New York.
7
Department of Medicine/Cardiology, UCLA Medical Center, Los Angeles, California.
8
Department of Medicine/Cardiology, UCLA Medical Center, Los Angeles, California; Department of Medicine/Cardiology, VA Medical Center, Los Angeles, California.
9
Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: timothy.henry@cshs.org.

Abstract

OBJECTIVES:

The study sought to compare the clinical efficacy and safety of P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous intervention (PPCI).

BACKGROUND:

Limited data exist regarding the comparative efficacy and safety of P2Y12 inhibitors in STEMI patients undergoing PPCI.

METHODS:

Clinical trials enrolling STEMI patients were identified and relevant data was extracted. Major adverse cardiovascular events (MACE) were defined as the composite of all cause mortality, MI, and target vessel revascularization. Network meta-analysis was performed using Bayesian methods.

RESULTS:

A total of 37 studies with 88,402 STEMI patients and 5,077 MACE were analyzed. Outcomes at 1 month (22 studies and 60,783 patients) suggest that prasugrel was associated with: lower MACE than clopidogrel (standard dose odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.50 to 0.69; high-dose OR: 0.60, 95% CI: 0.51 to 0.71; upstream OR: 0.79, 95% CI: 0.66 to 0.94), and ticagrelor (standard dose OR: 0.69, 95% CI: 0.56 to 0.84; upstream OR: 0.72, 95% CI: 0.50 to 1.05); lower mortality and MI than clopidogrel and standard ticagrelor; lower stroke risk than standard clopidogrel and standard or upstream ticagrelor; and lower stent thrombosis than standard or upstream clopidogrel. At 1-year (10 studies, n = 40,333) prasugrel was associated with lower mortality and MACE than other P2Y12 inhibitors. MACE was particularly lower with prasugrel in studies where patients received bivalirudin, drug-eluting stents, and but not glycoprotein IIb/IIIa inhibitor.

CONCLUSIONS:

In STEMI patients undergoing PPCI, prasugrel and ticagrelor are more efficacious than clopidogrel; in addition, prasugrel was superior to ticagrelor particularly in conjunction with bivalirudin and drug-eluting stents.

KEYWORDS:

P2Y(12) inhibitors; ST-segment elevation myocardial infarction; angioplasty; clopidogrel; percutaneous coronary intervention; prasugrel; thienopyridines; ticagrelor

PMID:
27198684
DOI:
10.1016/j.jcin.2016.02.013
[Indexed for MEDLINE]
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