Abstract

Objective

The optimal timing of P2Y12 inhibitors in patients with acute ST-segment elevation myocardial infarction (STEMI) is still controversial. In our study, the effect of loading in the emergency department or catheterization laboratory on in-hospital and 1-month mortality in patients presenting with STEMI was investigated.

Material and Methods

The study included 252 patients who first presented to the emergency department with acute STEMI and were treated with primary percutaneous coronary interventio (PCI) within the first 12 hours after the onset of symptoms. The patients were divided into 2 groups as those who underwent P2Y12 inhibitors loading in the emergency department (group 1) and those who underwent P2Y12 inhibitors loading after coronary anatomy was determined in cathater laboratory (group 2) (group 1: 154 patients, 110 males, 57.1±12.4 years, group 2: 98 patients, 78 males, 58.2±12.3 years). In addition to 300 mg acetylsalicylic acid, the patients were loaded with 180 mg ticagrelor or 600 mg clopidogrel. Adverse cardiac outcomes were recorded as the need for re-PCI after the procedure, failure to open the infarct-related artery, intubation, requirement to a respiratory support device or exitus of the patient in the hospital and within the following 1 month.

Results

It was recorded that 22 patients resulted in exitus and 38 patients had adverse cardiac outcomes. Ticagrelor was loaded in 229 patients and clopidogrel was loaded in 23 patients who could not be loaded with ticagrelor. In 4 patients (2.6%) who were loaded in the emergency department and in 7 patients (7.1%) who were loaded in the catheterization laboratory, adequate flow (≥TIMI 2) could not be achieved in the infarct-related artery after the procedure (p=0.068). In patients with group 1, exitus and major adverse cardiovascular events numbers were significantly lower than in those loaded in the catheterization laboratory (6 vs. 16: p=0.001, 15 vs. 23: p=0.003).

Conclusion

In patients presenting with acute STEMI, P2Y12 inhibitors in the emergency department have a more positive effect on in-hospital and 1-month mortality and adverse endpoints compared to P2Y12 inhibitors in the catheterization laboratory.