Abstract 16683: Pretreatment With Clopidogrel In ST-segment Elevation Myocardial Infarction. Evidence From a Meta-analysis
Background: Current ACC/AHA guidelines recommend a P2Y12 inhibitor in addition to aspirin in ST-segment elevation myocardial infarction (STEMI) patients either on presentation or in the cardiac catheterization laboratory (CCL). In contrast, European guidelines recommend P2Y12 inhibitor administration as soon as possible, but acknowledge that there is no enough evidence to support this class I recommendation.
Aim: Perform a meta-analysis to examine the hypothesis that pretreatment with clopidogrel in STEMI patients is superior to no pretreatment and CCL administration.
Methods: We performed a literature search for full length articles comparing clopidogrel administration on presentation (pretreatment) compared with CCL administration in STEMI patients undergoing percutaneous coronary intervention (PCI). We used odds ratio (OR) and random effects model for comparisons. We report mortality, major adverse cardiovascular events (MACE), major bleeding and reinfarction at 30 days.
Results: A total of 8 studies with 32,509 STEMI patients were included in the analysis. 30 day mortality was significantly lower with pretreatment compared to CCL administration, 4% vs 5% (OR 0.62, 95% confidence interval (CI) [0.46, 0.83]; P=0.002). MACE was significantly lower with pretreatment compared to CCL administration, 6.8% vs 6.3% (OR 0.69, 95% CI [0.58, 0.83]; P<0.0001). Major bleeding was also lower in the pretreatment group (OR 0.80, 95% CI [0.65, 0.97]; P=0.03) that was driven by one study which used more glycoprotein IIb/IIIa inhibitors and more 600 mg loading dose of clopidogrel in the no pretreatment arm. There was no significant difference in reinfarction rates between the groups, 2.6% vs 3.1%.
Conclusion: Clopidogrel administration at presentation for STEMI patients undergoing PCI decreases 30 day major adverse cardiovascular events and improves mortality.
Author Disclosures: R. Nairooz: None. Y. Rochlani: None. N. Pothineni: None. P. Sardar: None. D. Shavelle: Research Grant; Modest; St. Jude Medical, Abiomed, Abbott Vascular, NIH, Zoll, Neostim. Speakers Bureau; Modest; Maquet, Medtronic.
- © 2015 by American Heart Association, Inc.