Early treatment with inhibitors of P2Y12 receptor in patients with ST-segment elevation myocardial infarction - 2023 ESC recommendations and scientific evidence. Is clinical evidence sufficient to suggest a move towards precision medicine? The ELECTRA-SIRIO 2 investigators' viewpoint.
Jacek Kubica, Piotr Adamski, Jolita Badariene, Marc Bonaca, Piotr Buszman, Rahima Gabulova, Robert Gajda, Tobias Geisler, Robert Gil, Diana A Gorog, Paul A Gurbel, Tomasz Hajdukiewicz, Bartosz Hudzik, Stefan James, Young-Hoon Jeong, Adam Kern, Wacław Kochman, Aldona Kubica, Wiktor Kuliczkowski, Przemysław Magielski, Piotr Niezgoda, Małgorzata Ostrowska, Paolo Raggi, Uzeyir Rahimov, Grzegorz Skonieczny, Jolanta M Siller-Matula, Giuseppe Specchia, Łukasz Szarpak, Paweł Szymański, Udaya Tantry, Julia Umińska, Eliano Pio Navarese
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Abstract
The 2023 ESC guidelines changed previously recommended a strategy of early treatment in patients with STEMI. Pre-treatment with a P2Y12 receptor inhibitor may be considered in patients undergoing a primary PCI strategy (Class IIb, Level of evidence B). However, the available scientific evidence justifies a personalized approach differentiating the indications for pre-treatment with oral P2Y12 receptor inhibitors depending on the concomitant administration of opioids. In our opinion, in patients undergoing primary PCI not treated with opioids, pre-treatment with an oral P2Y12 receptor inhibitor should be applied, while in patients undergoing primary PCI treated with opioids, pre-treatment with an oral P2Y12 receptor inhibitor should be considered.
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