Research Article
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Year 2025, Volume: 7 Issue: 3, 11 - 20, 31.12.2025
https://doi.org/10.55994/ejcc.1698214

Abstract

References

  • World Health Organization. Cardiovascular diseases. Fact sheet No 317. 2011.
  • Fuster V, Badimon L, Badimon JJ, et al. The pathogenesis of coronary artery disease and the acute coronary syndromes (part 1). N Engl J Med. 1992;326(4):242-250.
  • Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104(3):365-372.
  • European Society of Cardiology. ESC 2012 NSTEMI guidelines [in Turkish]. 2012.
  • Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guidelines for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction: executive summary and recommendations. Circulation. 2000;102(10):1193-1209.
  • Cannon CP, McCabe CH, Stone PH, et al. The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q wave myocardial infarction: results of the TIMI III registry ECG ancillary study. J Am Coll Cardiol. 1997;30(1):133-140.
  • Antman EM, Tanasijevic MJ, Thompson B, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335(18):1342-1349.
  • Hamm CW, Goldmann BU, Heeschen C, et al. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or Troponin I. N Engl J Med. 1997;337(23):1648-1653.
  • Hamm CW, Heeschen C, Goldmann B, et al. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. N Engl J Med. 1999;340(21):1623-1629.
  • Wiviott S, Braunwald E, McCabe C, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001-2015.
  • Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction. J Am Coll Cardiol. 2007;50(1):1-157.
  • Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352(12):1179-1189.
  • Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569-2619.
  • Onat A, Keles Ş, Çetinkaya A, et al. Prevalence of coronary-related deaths and events in Turkish adults over a ten-year period: TEKHARF study data [in Turkish]. Turk Kardiyol Dern Ars. 2001;29(1):8-19.
  • Tavlı T, Pekel N. Risk factors in coronary artery disease [in Turkish]. Turkiye Klinikleri J Cardiol-Special Topics. 2011;4(2):16-20.
  • Aygül N, Özdemir K, Abacı A, et al. Prevalence of risk factors of ST-segment elevation myocardial infarction in Turkish patients living in Central Anatolia. Anatol J Cardiol. 2009;9(1):3-8.
  • Wiviott SD, Trenk D, Frelinger AL, et al. Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention. Circulation. 2007;116(25):2923-2932.
  • Mont'Alverne-Filho JR, Rodrigues-Sobrinho CR, Medeiros F, et al. Upstream clopidogrel, prasugrel, or ticagrelor for patients treated with primary angioplasty. Catheter Cardiovasc Interv. 2016;87(7):1187-1193.
  • Gibson CM. Has my patient achieved adequate myocardial reperfusion? Circulation. 2003;108(5):504-508.
  • Cannon CP, Weintraub WS, Demopoulos LA, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIB/IIIA inhibitor tirofiban. N Engl J Med. 2001;344(25):1879-1887.
  • Israrcı. Guidelines for the treatment of acute coronary syndromes (ACS) in patients without ST-segment elevation [in Turkish]. J Cardiol. 2011;86.
  • Cannon CP, Braunwald E. Unstable angina and non-ST elevation myocardial infarction. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease. 7th ed. Saunders; 2005:1243-1279.
  • O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Circulation. 2013;127(4):e362-e425.
  • Rittersma SZ, van der Wal AC, Koch KT, et al. Plaque instability frequently occurs days or weeks before occlusive coronary thrombosis. Circulation. 2005;111(9):1160-1165.
  • Matsis K, Holley A, Al-Sinan A, et al. Differing clinical characteristics between young and older patients presenting with myocardial infarction. Heart Lung Circ. 2017;26(1):40-47.
  • van Werkum JW, Heestermans AA, Zomer AC, et al. Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. J Am Coll Cardiol. 2009;53(16):1399-1409.
  • Onat A, Kaya A, Akbaş-şimşek T, et al. Twenty-five years of the TARF study: the 2015 survey, and temporal trends in mortality and loss to follow-up. Turk Kardiyol Dern Ars. 2016;44(5):365-370.
  • Greenland P, Reicher-Reiss H, Goldbourt U, et al. In-hospital and 1-year mortality in 1,524 women after myocardial infarction. Circulation. 1991;83(2):484-491.
  • Smilowitz NR, Mahajan A, Roe M, et al. In-hospital mortality of myocardial infarction by sex, age and obstructive coronary artery disease status. J Am Coll Cardiol. 2016;67(13):461-469.
  • Perl L, Sasson L, Weissler-Snir A, et al. Effects of prasugrel pretreatment on angiographic myocardial perfusion parameters in patients with ST-elevation myocardial infarction. Coron Artery Dis. 2015;26(8):665-670.

Comparison of Outcomes in Patients Presenting to the Emergency Department with Myocardial Infarction: Initial Administration of Oral Antithrombotic (P2Y12 Antagonist) Loading Therapy in the Emergency Setting

Year 2025, Volume: 7 Issue: 3, 11 - 20, 31.12.2025
https://doi.org/10.55994/ejcc.1698214

Abstract

Objective: We investigated the effect of the initial P2Y12 loading therapy in emergency department to clinical and angiographic results in patients admitted to the emergency department with myocardial infarction.
Material and Methods: The initial P2Y12 loading therapy in emergency department with clinical and angiographic results in the patients admitted to the emergency department with myocardial infarction and had undergone to coronary angiography in year 2015 were investigated retrospectively. The age, gender, co-morbid diseases, the loading P2Y12 therapy in emergency department, the TIMI flow rate and myocardial Blush grade before and after the angiography was recorded. The effect of the initial P2Y12 loading therapy in emergency department to clinical and angiographic results in patients admitted to the emergency department with myocardial infarction were investigated.
Results: The mean age of the males was 54.4±12.2 years and females was 65.2±13.9 years. The mean age of the females are greater than males significantly. Stent thrombosis is detected in 5.7% of the patients. The stent thrombosis was more frequently seen in patents with previous coronary artery disease. In-hospital mortality was 3.7%; the mortality rate after angioplasty was 1.98%. There was not any loading therapy in 65.3% of the patients; clopidogrel was loaded in 25%, ticagrelor was 2.2% and prasugrel was 7.4%. The TIMI score and blush grade was similar before angioplasty in all groups; also the TIMI score and blush grade was similar after angioplasty.
Discussion: In conclusion, the results the loading therapy with clopidogrel, ticagrelor and prasugrel in emergency department were similar. Both of the three agents effectivity are similar.

Ethical Statement

This retrospective study was designed to analyze data from patients presenting to the emergency department (ED) with acute myocardial infarction (STEMI/NSTEMI) who underwent emergency coronary angiography at Bağcılar Training and Research Hospital, following approval by the Institutional Ethics Committee.

Supporting Institution

No financial support was received for this study

References

  • World Health Organization. Cardiovascular diseases. Fact sheet No 317. 2011.
  • Fuster V, Badimon L, Badimon JJ, et al. The pathogenesis of coronary artery disease and the acute coronary syndromes (part 1). N Engl J Med. 1992;326(4):242-250.
  • Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104(3):365-372.
  • European Society of Cardiology. ESC 2012 NSTEMI guidelines [in Turkish]. 2012.
  • Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA guidelines for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction: executive summary and recommendations. Circulation. 2000;102(10):1193-1209.
  • Cannon CP, McCabe CH, Stone PH, et al. The electrocardiogram predicts one-year outcome of patients with unstable angina and non-Q wave myocardial infarction: results of the TIMI III registry ECG ancillary study. J Am Coll Cardiol. 1997;30(1):133-140.
  • Antman EM, Tanasijevic MJ, Thompson B, et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996;335(18):1342-1349.
  • Hamm CW, Goldmann BU, Heeschen C, et al. Emergency room triage of patients with acute chest pain by means of rapid testing for cardiac troponin T or Troponin I. N Engl J Med. 1997;337(23):1648-1653.
  • Hamm CW, Heeschen C, Goldmann B, et al. Benefit of abciximab in patients with refractory unstable angina in relation to serum troponin T levels. N Engl J Med. 1999;340(21):1623-1629.
  • Wiviott S, Braunwald E, McCabe C, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001-2015.
  • Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction. J Am Coll Cardiol. 2007;50(1):1-157.
  • Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352(12):1179-1189.
  • Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569-2619.
  • Onat A, Keles Ş, Çetinkaya A, et al. Prevalence of coronary-related deaths and events in Turkish adults over a ten-year period: TEKHARF study data [in Turkish]. Turk Kardiyol Dern Ars. 2001;29(1):8-19.
  • Tavlı T, Pekel N. Risk factors in coronary artery disease [in Turkish]. Turkiye Klinikleri J Cardiol-Special Topics. 2011;4(2):16-20.
  • Aygül N, Özdemir K, Abacı A, et al. Prevalence of risk factors of ST-segment elevation myocardial infarction in Turkish patients living in Central Anatolia. Anatol J Cardiol. 2009;9(1):3-8.
  • Wiviott SD, Trenk D, Frelinger AL, et al. Prasugrel compared with high loading- and maintenance-dose clopidogrel in patients with planned percutaneous coronary intervention. Circulation. 2007;116(25):2923-2932.
  • Mont'Alverne-Filho JR, Rodrigues-Sobrinho CR, Medeiros F, et al. Upstream clopidogrel, prasugrel, or ticagrelor for patients treated with primary angioplasty. Catheter Cardiovasc Interv. 2016;87(7):1187-1193.
  • Gibson CM. Has my patient achieved adequate myocardial reperfusion? Circulation. 2003;108(5):504-508.
  • Cannon CP, Weintraub WS, Demopoulos LA, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIB/IIIA inhibitor tirofiban. N Engl J Med. 2001;344(25):1879-1887.
  • Israrcı. Guidelines for the treatment of acute coronary syndromes (ACS) in patients without ST-segment elevation [in Turkish]. J Cardiol. 2011;86.
  • Cannon CP, Braunwald E. Unstable angina and non-ST elevation myocardial infarction. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald’s Heart Disease. 7th ed. Saunders; 2005:1243-1279.
  • O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Circulation. 2013;127(4):e362-e425.
  • Rittersma SZ, van der Wal AC, Koch KT, et al. Plaque instability frequently occurs days or weeks before occlusive coronary thrombosis. Circulation. 2005;111(9):1160-1165.
  • Matsis K, Holley A, Al-Sinan A, et al. Differing clinical characteristics between young and older patients presenting with myocardial infarction. Heart Lung Circ. 2017;26(1):40-47.
  • van Werkum JW, Heestermans AA, Zomer AC, et al. Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. J Am Coll Cardiol. 2009;53(16):1399-1409.
  • Onat A, Kaya A, Akbaş-şimşek T, et al. Twenty-five years of the TARF study: the 2015 survey, and temporal trends in mortality and loss to follow-up. Turk Kardiyol Dern Ars. 2016;44(5):365-370.
  • Greenland P, Reicher-Reiss H, Goldbourt U, et al. In-hospital and 1-year mortality in 1,524 women after myocardial infarction. Circulation. 1991;83(2):484-491.
  • Smilowitz NR, Mahajan A, Roe M, et al. In-hospital mortality of myocardial infarction by sex, age and obstructive coronary artery disease status. J Am Coll Cardiol. 2016;67(13):461-469.
  • Perl L, Sasson L, Weissler-Snir A, et al. Effects of prasugrel pretreatment on angiographic myocardial perfusion parameters in patients with ST-elevation myocardial infarction. Coron Artery Dis. 2015;26(8):665-670.
There are 30 citations in total.

Details

Primary Language English
Subjects Emergency Medicine
Journal Section Research Article
Authors

Nuşin Yalımol 0000-0002-4558-0868

Ertuğrul Okuyan 0000-0002-0626-2939

Mustafa Yalimol 0000-0003-4333-592X

Ali Sarıdaş 0000-0002-2725-6001

Submission Date May 13, 2025
Acceptance Date August 28, 2025
Publication Date December 31, 2025
Published in Issue Year 2025 Volume: 7 Issue: 3

Cite

AMA Yalımol N, Okuyan E, Yalimol M, Sarıdaş A. Comparison of Outcomes in Patients Presenting to the Emergency Department with Myocardial Infarction: Initial Administration of Oral Antithrombotic (P2Y12 Antagonist) Loading Therapy in the Emergency Setting. Eurasian j Crit Care. December 2025;7(3):11-20. doi:10.55994/ejcc.1698214