PMID- 30919382
OWN - NLM
STAT- MEDLINE
DCOM- 20191212
LR  - 20191217
IS  - 2567-689X (Electronic)
IS  - 0340-6245 (Linking)
VI  - 119
IP  - 6
DP  - 2019 Jun
TI  - Optimal Timing of P2Y12 Inhibitor Loading in Patients Undergoing PCI: A 
      Meta-Analysis.
PG  - 1000-1020
LID - 10.1055/s-0039-1683421 [doi]
AB  - BACKGROUND AND AIM:  The timing of P2Y12 inhibitor loading in patients undergoing 
      percutaneous coronary intervention (PCI) is a matter of debate. The aim of our 
      study was to compare the efficacy and safety of oral P2Y12 inhibitors: 
      clopidogrel, ticagrelor and prasugrel administered at two different time points 
      in relation to PCI: early (> 2 hours pre-PCI) versus late (< 2 hours pre-PCI or 
      post-PCI). METHODS:  This is a systematic review and meta-analysis. Randomized 
      controlled trials and non-randomized studies were included. Outcomes evaluated 
      were combined major adverse cardiovascular events (MACEs), myocardial infarction 
      (MI), target vessel revascularization, death and bleeding complications. Summary 
      estimates of the relative risks with therapy were calculated. RESULTS: 
       Twenty-three studies met the selection criteria and included 60,907 patients. 
      Early P2Y12 inhibitor loading was associated with a 22% relative risk reduction 
      (RRR) of MACE (95% confidence interval [CI] = 0.68-0.89; p < 0.001). Early 
      clopidogrel loading was associated with a 25% RRR of MACE (95% CI = 0.65-0.85; 
      p < 0.001), a 30% RRR of MI (95% CI = 0.6-0.82; p < 0.0001) and 25% RRR of death 
      (95% CI = 0.64-0.87; p = 0.0002), without an impact on major bleedings. In 
      ST-elevation myocardial infarction as well as non-ST elevation acute coronary 
      syndrome (NSTE-ACS), early clopidogrel loading resulted in 35 and 22% RRR in 30 
      days MACE (p < 0.001), respectively, with no impact in elective PCI. Whereas 
      early loading with prasugrel and ticagrelor did not improve ischaemic outcomes, 
      prasugrel administered early increased bleeding risks in NSTE-ACS. CONCLUSION: 
       Early clopidogrel loading is associated with a better efficacy and similar 
      safety, whereas timing of ticagrelor or prasugrel loading had no effects on 
      ischaemic events.
CI  - Georg Thieme Verlag KG Stuttgart . New York.
FAU - Komosa, Anna
AU  - Komosa A
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Lesiak, Maciej
AU  - Lesiak M
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Krasinski, Zbigniew
AU  - Krasinski Z
AD  - Department of General and Vascular Surgery, Poznan University of Medical 
      Sciences, Poznan, Poland.
FAU - Grygier, Marek
AU  - Grygier M
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Siniawski, Andrzej
AU  - Siniawski A
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Skorupski, Wlodzimierz
AU  - Skorupski W
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Olasinska-Wisniewska, Anna
AU  - Olasinska-Wisniewska A
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Pyda, Malgorzata
AU  - Pyda M
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Araszkiewicz, Aleksander
AU  - Araszkiewicz A
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Mitkowski, Przemyslaw
AU  - Mitkowski P
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Grajek, Stefan
AU  - Grajek S
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Mularek-Kubzdela, Tatiana
AU  - Mularek-Kubzdela T
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
FAU - Hengstenberg, Christian
AU  - Hengstenberg C
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria.
FAU - Siller-Matula, Jolanta M
AU  - Siller-Matula JM
AD  - 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, 
      Poland.
AD  - Division of Cardiology, Department of Internal Medicine II, Medical University of 
      Vienna, Vienna, Austria.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20190327
PL  - Germany
TA  - Thromb Haemost
JT  - Thrombosis and haemostasis
JID - 7608063
RN  - 0 (Purinergic P2Y Receptor Antagonists)
RN  - A74586SNO7 (Clopidogrel)
RN  - G89JQ59I13 (Prasugrel Hydrochloride)
RN  - GLH0314RVC (Ticagrelor)
SB  - IM
MH  - Acute Coronary Syndrome/*epidemiology/mortality/therapy
MH  - Clinical Protocols
MH  - Clinical Trials as Topic
MH  - Clopidogrel/therapeutic use
MH  - Humans
MH  - *Percutaneous Coronary Intervention
MH  - Postoperative Complications/*epidemiology/mortality/prevention & control
MH  - Prasugrel Hydrochloride/therapeutic use
MH  - Purinergic P2Y Receptor Antagonists/*therapeutic use
MH  - Risk
MH  - Survival Analysis
MH  - Ticagrelor/therapeutic use
MH  - *Time Factors
COIS- None declared.
EDAT- 2019/03/29 06:00
MHDA- 2019/12/18 06:00
CRDT- 2019/03/29 06:00
PHST- 2019/03/29 06:00 [pubmed]
PHST- 2019/12/18 06:00 [medline]
PHST- 2019/03/29 06:00 [entrez]
AID - 10.1055/s-0039-1683421 [doi]
PST - ppublish
SO  - Thromb Haemost. 2019 Jun;119(6):1000-1020. doi: 10.1055/s-0039-1683421. Epub 2019 
      Mar 27.