P2Y12 Inhibitor Selection in STEMI — EECC MCQ

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EasyCoronary Artery DiseaseP2Y12 Inhibitor Selection in STEMIEECC

A 54-year-old man with an anterior STEMI undergoes primary PCI. He has no history of stroke or TIA, weighs 85 kg, and is under 75 years of age. Which P2Y12 inhibitor is preferred as loading dose in the catheterisation laboratory?

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Correct answer: A — Prasugrel 60 mg

For acute STEMI treated with primary PCI in UK practice, the preferred oral P2Y12 inhibitor as part of DAPT with aspirin is prasugrel, provided there is no separate need for oral anticoagulation and no major prasugrel contraindication. This patient is <75 years, weighs >60 kg, and has no previous stroke/TIA, so he is an appropriate candidate. The correct catheter-laboratory loading regimen is prasugrel 60 mg, followed by maintenance therapy. Ticagrelor is an alternative in some contexts but is not the preferred answer here; clopidogrel is used when prasugrel/ticagrelor are unsuitable or when oral anticoagulation is required; cangrelor is intravenous and reserved for selected situations where oral P2Y12 therapy is not feasible or has not been given.

Reference: NICE guideline NG185: Acute coronary syndromes, recommendation 1.1.11, 2020. https://www.nice.org.uk/guidance/ng185/chapter/Recommendations