title: Optimal P2Y12 Inhibitor in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Network Meta-Analysis.
abstract: 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).
  
  
  
  Limited data exist regarding the comparative efficacy and safety of P2Y12 inhibitors in STEMI patients undergoing PPCI.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Medicine/Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California; Department of Medicine/Cardiology, UCLA Medical Center, Los Angeles, California.
authors.forename: Asim M
authors.initials: AM
authors.lastname: Rafique
authors.affiliation: Department of Medicine/Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Piyush
authors.initials: P
authors.lastname: Nayyar
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York.
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.affiliation: Department of Medicine/Cardiology, Mount Sinai Hospital, New York, New York.
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.affiliation: Northwell Health, New York, New York.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Berger
authors.affiliation: Department of Medicine/Cardiology, UCLA Medical Center, Los Angeles, California.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Tobis
authors.affiliation: Department of Medicine/Cardiology, UCLA Medical Center, Los Angeles, California; Department of Medicine/Cardiology, VA Medical Center, Los Angeles, California.
authors.forename: Jesse
authors.initials: J
authors.lastname: Currier
authors.affiliation: Department of Medicine/Cardiology, UCLA Medical Center, Los Angeles, California.
authors.forename: Ravi H
authors.initials: RH
authors.lastname: Dave
authors.affiliation: Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: timothy.henry@cshs.org.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Henry
mesh_terms: D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use; D001499:Bayes Theorem; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D003328:Coronary Thrombosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D054855:Drug-Eluting Stents; D019317:Evidence-Based Medicine; D006629:Hirudins; D006801:Humans; D008390:Markov Chains; D009010:Monte Carlo Method; D016017:Odds Ratio; D010446:Peptide Fragments / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use; D058921:Purinergic P2Y Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000991:Antithrombins; D006629:Hirudins; C548576:P2RY12 protein, human; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D011994:Recombinant Proteins; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D013988:Ticlopidine; C074619:bivalirudin
keywords: P2Y(12) inhibitors; ST-segment elevation myocardial infarction; angioplasty; clopidogrel; percutaneous coronary intervention; prasugrel; thienopyridines; ticagrelor