Comparıson of effect and side effect profiles of different P2Y12 inhibitors in patients with acute ST-segment Elevation Myocardial Infarction in the COVID era: Retrospective study

Objective: Coronavirus disease (COVID) is a disease that can progress with common thrombosis and bleeding complications due to endothelial dysfunction. Dual antiplatelet therapy used to reduce the risk of stent thrombosis in ST Elevation Myocardial Infarction (STEMI) patients may increase the risk of bleeding. The aim of this study is to compare the effect and side effect profiles of P2Y12 inhibitors used in the COVID period. Method: Our study included 390 patients who underwent primary coronary angiography with the diagnosis of STEMI between January 1, 2020 and December 31, 2021. Retrospectively, patients were divided into groups according to their COVID status. Groups were compared for all-cause death, cardiac death, stent thrombosis, and bleeding complications at hospitalization and during 1-year follow-up. Findings: The mean age of the patients was 64.3 years and the mean follow-up period was 10.2 months. While 80% of the patient group were male, 20% were female. 44.6% of the patients have a history of COVID infection. In our study, the in-hospital mortality rate was found to be 11.3%. When the P2Y12 inhibitor groups were compared, cardiac mortality was found to be significantly higher in the clopidogrel group than in the other groups, regardless of the COVID history. While the rate of cardiac mortality was 21.9% in the clopidogrel group, it was 1.6% in the prasugrel group and 6.7% in the ticagrelor group (p<0.001). When the effect and side-effect profiles of P2Y12 inhibitors were compared, no difference in clinical outcome could be detected in patients who had COVID compared to those who did not during the 1-year follow-up period. Conclusion: No significant difference was found in the efficacy and safety endpoints of different P2Y12 inhibitors among patients with STEMI in the COVID era. Key words: Acute coronary syndrome, P2Y12 inhibitor, Coronavirus disease