Archives of Academic Emergency Medicine
Early Oral P2Y12 Inhibitor Loading in Patients with ST-segment Eleva-tion Myocardial Infarction Undergoing Primary PCI: A Systematic Re-view and Meta-analysis
By Pshtiwan Hussein Qadir.
Abstract
Introduction
Whether oral P2Y12 inhibitor loading should be given before hospital arrival or deferred until angiography remains uncertain in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We compared the efficacy and safety of early loading with later in-hospital, catheterization-laboratory, downstream, or no pretreatment.
Methods
PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception through July 2026 without a language restriction. Randomized and nonrandomized comparative studies of adults with STEMI undergoing primary PCI were eligible. Primary random-effects meta-analyses used restricted maximum likelihood (REML) when at least three independent studies were available. A direct prehospital analysis was defined in the working analysis plan before final pooling. Because the review was not prospectively registered, these analytical decisions are described as predefined rather than as claims of prospective protocol registration.