| Summary: | Introduction and objectives: In ST-segment elevation myocardial infarction (STEMI) the benefit of dual antiplatelet therapy is unequivocal, but the optimal time to administer the loading dose (LD) of a P2Y12 inhibitor is the subject of debate and disagreement. The main aim of this study was characterize current practice in Portugal and to assess the prognostic impact of P2Y12 inhibitor LD administration strategy, before versus during or after primary percutaneous coronary intervention (PCI). Methods: This multicenter retrospective study based on the Portuguese National Registry on Acute Coronary Syndromes included patients with STEMI and PCI performed between October 1, 2010 and September 19, 2017. Two groups were established: LD before PCI (LD-PRE) and LD during or after PCI (LD-CATH). Results: A total of 4123 patients were included, 66.3% in the LD-PRE group and 32.4% in the LD-CATH group. Prehospital use of a P2Y12 inhibitor was a predictor of the composite bleeding endpoint (major bleeding, need for transfusion or hemoglobin [Hb] drop >2 g/dl), Hb drop >2 g/dl and reinfarction. There were no differences between groups in major adverse events (MAE) (in-hospital mortality, reinfarction and stroke) or in-hospital mortality. Conclusions: Prehospital use of a P2Y12 inhibitor was associated with an increased risk of bleeding, predicting the composite bleeding outcome and Hb drop>2 g/dl, with no differences in mortality or MAE, calling into question the benefit of this strategy. Resumo: Introdução e objetivos: No enfarte agudo do miocárdio com supra desnivelamento do segmento ST (EAMcST) é inequívoco o benefício do uso de dupla anti-agregação plaquetar. O tempo ideal para administrar a dose de carga do inibidor do recetor P2Y12 (DC-iP2Y12) é pouco consensual e motivo de debate. O principal objetivo do trabalho foi caracterizar a prática usada em Portugal e avaliar o impacto prognóstico da estratégia de administração da DC-iP2Y12, se antes ou durante/após angioplastia primária (AP). Métodos: Estudo multicêntrico, retrospetivo, baseado no Registo Nacional de Síndromes Coronárias Agudas, com inclusão de doentes com EAMcST e AP realizada de 1/10/2010 a 19/09/2017. Estabelecidos dois grupos: DC-iP2Y12 pré-AP (PRE-DC-iP2Y12) e DC-iP2Y12 durante ou após AP (CAT-DC-iP2Y12). Resultados: Incluídos 4123 doentes, 66,3% do grupo PRE-DC-iP2Y12 e 32,4% do grupo CAT-DC-iP2Y12. Numa análise multivariada o uso de PRE-DC-iP2Y12 foi preditor de HEMATS (endpoint composto por hemorragia major, transfusão de sangue e queda de hemoglobina (Hb)>2 g/dL), queda de Hb>2 g/dL e re-enfarte. Não se verificaram diferenças entre grupos no MACE (endpoint composto por morte hospitalar, acidente vascular cerebral e re-enfarte) e morte hospitalar. Conclusões: O uso de PRE-DC-iP2Y12 associou-se a um aumento do risco hemorrágico, sendo preditor do outcome composto de hemorragia (HEMATS) e de queda de Hb>2 g/dL, sem diferenças significativas na mortalidade e no MACE, o que coloca em questão o benefício desta estratégia.
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