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 Kubica¹, Piotr Adamski¹, Jolita Badariene², Marc Bonaca³, Piotr Buszman⁴, Rahima Gabulova⁵, Robert Gajda⁶, Tobias Geisler⁷, Robert Gil⁸, Diana A Gorog^{9

10

11}, Paul A Gurbel¹², Tomasz Hajdukiewicz¹³, Bartosz Hudzik^{14

15}, Stefan James¹⁶, Young-Hoon Jeong^{17

18}, Adam Kern¹⁹, Wacław Kochman²⁰, Aldona Kubica²¹, Wiktor Kuliczkowski²², Przemysław Magielski²³, Piotr Niezgoda²⁴, Małgorzata Ostrowska¹, Paolo Raggi²⁵, Uzeyir Rahimov²⁶, Grzegorz Skonieczny²⁷, Jolanta M Siller-Matula²⁸, Giuseppe Specchia²⁹, Łukasz Szarpak³⁰, Paweł Szymański³¹, Udaya Tantry¹², Julia Umińska¹, Eliano Pio Navarese³²

Affiliations

¹ Department of Cardiology and Internal Medicine, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
² Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
³ CPC Clinical Research, Aurora, United States.
⁴ Cardiology Department, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland; Center for Cardiology and Cardiac Surgery of American Heart of Poland, Bielsko-Biała, Poland.
⁵ Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku, Azerbaijan.
⁶ Gajda-Med District Hospital in Pultusk, Poland.
⁷ Medical Clinic III, University Hospital Tübingen, Tübingen, Germany.
⁸ Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.
⁹ Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom.
¹⁰ Faculty of Medicine, National Heart and Lung Institute, London, United Kingdom.
¹¹ Cardiology Department, Royal Brompton & Harefield NHS Trust, Part of Guys and St Thomas' Hospitals, London, United Kingdom.
¹² Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States.
¹³ Department of Cardiology, Provincial Hospital, Elblag, Poland.
¹⁴ Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland.
¹⁵ Third Department of Cardiology, Silesian Center for Heart Disease, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland.
¹⁶ Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
¹⁷ CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea.
¹⁸ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
¹⁹ Department of Cardiology and Internal Medicine, Medical Faculty, University of Warmia and Mazury in Olsztyn, Poland.
²⁰ The National Institute of Cardiology, Department of Cardiology, Bielanski Hospital, Warsaw, Poland.
²¹ Department of Cardiac Rehabilitation and Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
²² Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
²³ Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.
²⁴ Department of Cardiology and Internal Medicine, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland. piotr.niezgoda1986@gmail.com.
²⁵ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
²⁶ Department of Cardiology, Baku Medical Plaza, Baku, Azerbaijan.
²⁷ Department of Cardiology and Intensive Cardiological Care, Rydygier Provincial Hospital, Torun, Poland.
²⁸ Department of Cardiology, Medical University of Vienna, Vienna, Austria.
²⁹ Department of Cardiology, Policlinico di Monza, Monza, Italy.
³⁰ Department of Clinical Research and Development, LUXMED Group, Warsaw, Poland.
³¹ Department of Cardiology, Interventional Cardiology and Electrophysiology with Cardiac Intensive Care Unit, Tertiary Care Hospital in Grudziadz, Poland.
³² Clinical and Interventional Cardiology, Sassari University Hospital, Italy.

PMID: 40109248
PMCID: PMC12068194
DOI: 10.5603/cj.99973

Review

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 et al. Cardiol J. 2025.

. 2025;32(2):189-194.

doi: 10.5603/cj.99973. Epub 2025 Mar 20.

Authors

Affiliations

¹ Department of Cardiology and Internal Medicine, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
² Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
³ CPC Clinical Research, Aurora, United States.
⁴ Cardiology Department, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland; Center for Cardiology and Cardiac Surgery of American Heart of Poland, Bielsko-Biała, Poland.
⁵ Teaching-Therapeutical Hospital, Azerbaijan Medical University, Baku, Azerbaijan.
⁶ Gajda-Med District Hospital in Pultusk, Poland.
⁷ Medical Clinic III, University Hospital Tübingen, Tübingen, Germany.
⁸ Department of Invasive Cardiology, Centre of Postgraduate Medical Education, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.
⁹ Postgraduate Medical School, University of Hertfordshire, Hertfordshire, United Kingdom.
¹⁰ Faculty of Medicine, National Heart and Lung Institute, London, United Kingdom.
¹¹ Cardiology Department, Royal Brompton & Harefield NHS Trust, Part of Guys and St Thomas' Hospitals, London, United Kingdom.
¹² Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States.
¹³ Department of Cardiology, Provincial Hospital, Elblag, Poland.
¹⁴ Department of Metabolic Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland.
¹⁵ Third Department of Cardiology, Silesian Center for Heart Disease, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland.
¹⁶ Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
¹⁷ CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea.
¹⁸ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
¹⁹ Department of Cardiology and Internal Medicine, Medical Faculty, University of Warmia and Mazury in Olsztyn, Poland.
²⁰ The National Institute of Cardiology, Department of Cardiology, Bielanski Hospital, Warsaw, Poland.
²¹ Department of Cardiac Rehabilitation and Health Promotion, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
²² Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
²³ Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland.
²⁴ Department of Cardiology and Internal Medicine, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland. piotr.niezgoda1986@gmail.com.
²⁵ Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
²⁶ Department of Cardiology, Baku Medical Plaza, Baku, Azerbaijan.
²⁷ Department of Cardiology and Intensive Cardiological Care, Rydygier Provincial Hospital, Torun, Poland.
²⁸ Department of Cardiology, Medical University of Vienna, Vienna, Austria.
²⁹ Department of Cardiology, Policlinico di Monza, Monza, Italy.
³⁰ Department of Clinical Research and Development, LUXMED Group, Warsaw, Poland.
³¹ Department of Cardiology, Interventional Cardiology and Electrophysiology with Cardiac Intensive Care Unit, Tertiary Care Hospital in Grudziadz, Poland.
³² Clinical and Interventional Cardiology, Sassari University Hospital, Italy.

PMID: 40109248
PMCID: PMC12068194
DOI: 10.5603/cj.99973

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.

Keywords: ACS; ESC guidelines; P2Y12; STEMI; pretreatment.

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Conflict of interest statement

Conflict of interests: S. James: Intuitional research grants from Astra Zeneca, Janssen, Amgen, MSD, Novo Nordisk, SFJ pharmaceuticals; D. Gorog: Institutional research grants from AstraZeneca, Medtronic, Bayer, Werfen. Speaker’s bureau/advisory board: Janssen, BMS, Bayer.

Figures

**Central illustration**
The evolution of early antiplatelet therapy in STEMI

See this image and copyright information in PMC

References

1. Byrne RA, Rossello X, Coughlan JJ, et al. ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J. 2023;44(38):3720–3826. doi: 10.1093/eurheartj/ehad191. - DOI - PubMed
1. Ibanez B, James S, Agewall S, et al. ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC. Eur Heart J. 2018;39(2):119–177. doi: 10.1093/eurheartj/ehx393. - DOI - PubMed
1. Wiviott SD, Braunwald E, McCabe CH, et al. TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–2015. doi: 10.1056/NEJMoa0706482. - DOI - PubMed
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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

Affiliations

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

Authors

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Abstract

Conflict of interest statement

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